International Journal of Sport Nutrition and Exercise Metabolism, 2019, 29, 106-116
https://doi.org/10.1123/ijsnem.2018-0241© 2019 Human Kinetics, Inc.

SCHOLARLY REVIEW

Contemporary Nutrition Interventions to Optimize Performancein Middle-Distance Runners
Trent Stellingwerff
Canadian Sport Institute Paciﬁc, Athletics Canada, and University of Victoria

Ingvill Måkestad Bovim
Norwegian Sports Medicine Centre

Jamie Whitfield
Australian Catholic University
Middle-distance runners utilize the full continuum of energy systems throughout training, and given the inﬁnite competition
tactical scenarios, this event group is highly complex from a performance intervention point of view. However, this complexity
results in numerous potential periodized nutrition interventions to optimize middle-distance training adaptation and competition
performance. Middle-distance race intensity is extreme, with 800- to 5,000-m races being at ∼95% to 130% of VO2max.
Accordingly, elite middle-distance runners have primarily Type IIa/IIx ﬁber morphology and rely almost exclusively on
carbohydrate (primarily muscle glycogen) metabolic pathways for producing adenosine triphosphate. Consequently, theprinciple nutritional interventions that should be emphasized are those that optimize muscle glycogen contents to support
high glycolytic ﬂux (resulting in very high lactate values, of >20 mmol/L in some athletes) with appropriate buffering
capabilities, while optimizing power to weight ratios, all in a macro- and microperiodized manner. From youth to elite level,
middle-distance athletes have arduous racing schedules (10–25 races/year), coupled with excessive global travel, which cantake a physical and emotional toll. Accordingly, proactive and integrated nutrition planning can have a profound recovery effectover a long race season, as well as optimizing recovery during rounds of championship racing. Finally, with evidence-based
implementation and an appropriate risk/reward assessment, several ergogenic aids may have an adaptive and/or performanceenhancing effect in the middle-distance athlete. Given that elite middle-distance athletes undertake ∼400 to 800 training sessions
with 10–25 races/year, there are countless opportunities to implement various periodized acute and chronic nutrition-based
interventions to optimize performance.
Keywords: elite, ergogenic aids, nutrition periodization
Middle-distance running events are highly complex from aperformance optimization point of view. For example, elite middledistance specialists need to have the aerobic system development
approaching marathoners, coupled with some of the mechanicalproperties of elite sprinters, while concurrently having worldclass anaerobic capacities with polished tactical race instincts(Hanley & Hettinga, 2018; Sandford et al., 2018). These performance requirements result in highly complex training approaches,with signiﬁcant differences within and between athletes throughout
macro- (yearly/monthly) and micro- (weekly/within-day) cycle
periods (Martin & Coe, 1991). Accordingly, given that elite middle-distance athletes undertake ∼400 to 800 unique yearly training
sessions, and race 10–20 times per year (personal observations),
Stellingwerff is with the Canadian Sport Institute Paciﬁc, Victoria, British Columbia, Canada; Athletics Canada, Ottawa, Ontario, Canada; and the Dept. of Exercise
Science, Physical and Health Education, University of Victoria, Victoria, British
Columbia, Canada. Bovim is with Norwegian Sports Medicine Centre, Oslo,
Norway. Whitﬁeld is with Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne,
Victoria, Australia. Address author correspondence to Trent Stellingwerff at
tstellingwerff@csipaciﬁc.ca.

106

there are countless opportunities to implement various periodized
acute and chronic nutrition-based interventions. Therefore, thepurpose of this review is to provide an evidence-based update since
the last International Association of Athletics Federations (IAAF)
consensus meeting (Stellingwerff et al., 2007) on contemporary
nutrition recommendations to optimize adaptation to training
and enhance competition performance in elite middle-distanceathletes. The focus of this review will be on IAAF events ranging
from 800 to 5,000 m, termed middle-distance events hereafter.
Where possible we will integrate practical recommendations coupled with peer-reviewed data to support our nutritional recommendations. However, given the event group complexity and thenumerous potential interventions, many of the other IAAF papers
will be referenced, and this review will focus exclusively on key
novel interventions for middle-distance athletes.

Physiological and Bioenergetic
Determinants of Middle-Distance Success
The complexity of middle-distance running performance determinants includes physiological aspects such as bioenergetics/energy

Nutrition for Middle-Distance Athletes

Gastin, 2001), and only key elements will be described here
(Figure 1).
Middle-distance race intensity is extreme, with 800- to 5,000-m
races being at ∼95% to 130% of VO2max (Dufﬁeld et al., 2005),
or 75–85% of maximum sprint speed (Figure 1). Given these race
intensities and required training intensities, middle-distance athletes have a high number and highly developed Type IIa/IIx(intermediate) ﬁber morphology (Costill et al., 1976) and rely
almost exclusively on carbohydrate (CHO; primarily muscle
glycogen) and phosphocreatine metabolic pathways for producing
ATP. Accordingly, most middle-distance athletes can generatepeak lactate values over 20 mmol/L resulting in muscle pH values
as low as 6.6 (Hermansen & Osnes, 1972). Therefore, middledistance athletes have highly reﬁned anaerobic capacities, ortolerance, which is certainly a product of highly developed intermediate Type IIa (fast oxidative) ﬁber types, which are especiallyhigh in muscle carnosine concentrations. Carnosine is an undisputed pH buffer contributing as much as 15% to total muscle
buffering capacity, as it has long been known that sprinters androwers have nearly double the amount of muscle carnosine thanmarathon runners, strongly correlating to their Type II muscle ﬁber

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systems (Dufﬁeld et al., 2005; Spencer & Gastin, 2001), but mostcertainly also includes elements such as biomechanics/structural(force, stride frequency, body mass [BM]) aspects (Weyand &Davis, 2005) as well as numerous sociological and psychologicalconstructs. However, the majority of nutritional-based interventions that impact middle-distance performances are bioenergetically based and, thus, will be the determinants of performance
focus in this article (Figures 1 and 2). For individuals interested innutrition interventions in events of a biomechanical and structural
performance origin, please see Sygo et al. (2018). In order tounderstand how these interventions may relate to the energetic
demands of a given exercise bout, it is imperative to understandhow the various metabolic pathways interact in order to produce therequired amounts of adenosine triphosphate (ATP). This understanding best informs potential nutritional interventions that may
impact training adaptation and/or performance in a periodized
manner. This is especially important in middle-distance events
since they rely heavily on both substrate-level phosphorylation(anaerobic) and oxidative phosphorylation (aerobic) ATP production. The energy system aspects of middle-distance running has
been well described previously (Dufﬁeld et al., 2005; Spencer &107

Figure 1 — Differences in ATP energy source provision in middle-distance events within the context of ﬁber types and endogenous nutrition
considerations. It should be noted that ﬁber typing is a continuum, and only 100- to 400-m athletes have >60% Type IIx ﬁber types, while most middledistance athletes Type I ﬁbers range from 40% to 70% (Costill et al., 1976). ATP = adenosine triphosphate; FFA = free fatty acids; PCr = phosphocreatine;
prod. = production. Data adapted from Astrand et al. (1986), Costill et al. (1976), Gaston (1998), and Spencer and Gastin (2001).
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Figure 2 — Framework of the interactions between the structural and physiological determinants of performance (in white boxes) and potential
nutritional interventions (black boxes) in middle-distance athletes. It should be highlighted that performance determinates are a continuum, with middledistance athletes featuring both structural and physiological elements. Some nutrition interventions are acute (e.g., caffeine), while others are chronic in
combination with training (e.g., creatine supplementation). A dotted line indicates a potential training-induced nutritional adaptation. A question mark (?)
highlights the requirement for more scientiﬁc validation. ATP = adenosine triphosphate; CHO = carbohydrate; EA = energy availability; FFM = fat-freemass; HR = heart rate; La = lactate; LT = lactate threshold; NM = neuromuscular; PCr = phosphocreatine; PRO = protein; RFD = rate of force
development; suppl. = supplementation; SV = stroke volume; VO2max = maximal oxygen consumption.

morphology (Parkhouse et al., 1985). However, when considering
the entire spectrum of middle-distance race durations (∼1.5 to
15 min), the majority of middle-distance events are highly aerobic
and require signiﬁcant aerobic capacity development, as the measured aerobic contributions from 800 to 5,000 m range from ∼50%
to 95% (Figure 1). Indeed, the majority of aerobic ATP production
during intense exercise comes from glycolysis (primarily glycogenbreakdown) and the aerobic disposal of pyruvate via the enzyme
pyruvate dehydrogenase into the mitochondria (Parolin et al.,1999). There is also very large variability between athletes inaerobic versus anaerobic ATP contribution, especially over the
800-m event (1.5–2 min), with anaerobic contributions to the 800m event ranging from 19% to 48%, depending on the ﬁtness of thesubject and methods used (Dufﬁeld et al., 2005; Spencer & Gastin,2001). A lot of this variability is probably due to the fact that
middle-distance racing also involves nearly peak speed running(Sandford et al., 2018), which is more impacted by biomechanics
and structural constraints (Weyand et al., 2005) outlined in Figure 2,
including the key emerging concept of anaerobic speed reserve(Buchheit & Laursen, 2013). Anaerobic speed reserve is thedifference between an athlete’s maximal sprint speed and velocity
at VO2max, featuring structural/biomechanical considerations for
maximal sprint speed as well as energy system interventions forvelocity at VO2max (Figure 2).
Bioenergetics during racing is exponentially more complicated when considering the inﬁnite tactical situations. For example,
middle-distance events are not run in lanes and feature drafting(drafting in still wind at middle-distance speeds has been shown to

reduce VO2 cost by ∼2% to 4% (∼0.3 to 1.0 s/lap; Pugh, 1971) andconstant tactical decision making, which affect aerobic versus
anaerobic components and the anaerobic speed reserve continuum.
Furthermore, since middle-distance events are run at such highintensities, there is very little room for tactical errors because theycome at such a high metabolic cost. Therefore, aerobic andanaerobic pathways need to produce remarkable rates of ATP for
middle-distance success. Accordingly, from a bioenergetic perspective, optimizing muscle glycogen contents to support highglycolytic ﬂux (resulting in very high lactate values) with appropriate buffering capabilities, while optimizing power to weightratios, are the principle nutritional interventions to emphasize in
middle-distance runners (Figure 2).

Periodized Nutritional Strategies to Support
Periodized Training
The concept of nutrition periodization has been emerging as a key
construct to optimize sports-speciﬁc nutrition recommendations(Jeukendrup, 2017; Stellingwerff et al., 2007, 2011), with mostof these papers focusing on macronutrition periodization. Morerecently the concept of dietary microperiodization (weeks towithin-day) has been termed, which examines the temporal associations between speciﬁc training stimuli, daily life demands andassociated nutrition choices (Heikura et al., 2017a). This section
will focus on novel macro- to micronutrition periodization interventions in middle-distance athletes, with further nutrition

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Nutrition for Middle-Distance Athletes

periodization recommendations(Stellingwerff et al., 2018).

made

by

Mortonetal.

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Macroperiodization (Months to Weeks) Nutrition
Recommendations
Theoretical guidelines for seasonal macroperiodization of nutrition
for middle-distance runners across their periodized plans havepreviously been presented (Stellingwerff et al., 2007, 2011), anddata on typical dietary intakes of middle-distance athletes arefeatured here (Heikura et al., 2017a, 2017b; 2018). Most elite
middle-distance runners train like marathoners during the general
preparation phase, with high, but highly variable, volumes during
the fall/winter (∼40 to 180 km/week). Subsequently, training
gradually shifts throughout the season to higher intensities/lower
volumes and major anaerobic-based sessions toward the peakseason. Therefore, the optimal nutrition for an athlete will varyconsiderably in amount (calories) and type (macronutrient proﬁle)in conjunction with the phase-speciﬁc training demands. Since
the majority of middle-distance training is performed at or above
75% VO2max, and this dependency on CHO-based ATP provision
increases throughout the training year toward a championshippeak, CHO -rich foods must provide the majority of the energy
provision. Accordingly, a habitually high CHO diet with 7–10 g
CHO·kg BM−1·day−1 is recommended to restore glycogen stores,
with protein (PRO) intake during hard training phases at ∼1.5 to
1.7 g PRO−1·kg BM−1·day−1, but substantially less CHO is requiredon easy days, and during rest and recovery phases. There have been
no major alternations to these original recommendations(Stellingwerff et al., 2007, 2011); instead, this review will focus
on novel approaches.
Regarding the appropriate macroperiodization of calories, a
research ﬁeld that has received much recent attention has been therelative energy deﬁciency in sport (RED-S) and the impact thatchronic energy availability (EA) can have on health, body composition, and performance (reviewed here: Melin et al., 2018).
Macroperiodization of EA (deﬁned as energy intake minus exercise
energy expenditure) underpins the optimization of body composition periodization. In terms of middle-distance athlete health, a very
recent multicenter/multicountry paper (n = 59 athletes) examined
relative energy deﬁciency in sport indicators, prevalence, andsymptoms. This paper demonstrated that amenorrheic females(37% of females) and males in the lowest quartile of testosterone(15.1 ± 3.0 nmol/L; 42% of males) had 10-fold higher missed
training days and 4.5 times the number of bone injuries than therest of the athletes (Heikura et al., 2018). Given that the likelihoodof achieving a performance goal decreases sevenfold in track andﬁeld athletes over a 5-year period when completing less than 80%
of planned training weeks (Raysmith & Drew, 2016), the impactthat optimal dietary EA can have on health and performance of
middle-distance runners is profound.
However, a key performance indicator for elite middledistance runners is having a very high power to weight ratio,
which features elite athletes who have very low levels of body fat
during peak championship season, which may result in undesirable
relative energy deﬁciency in sport outcomes. Therefore, it is notsustainable from a health perspective to be at peak body composition year-round, so body composition needs to be strategicallyperiodized. The limited published body composition ranges suggest elite female middle-distance runners are ∼8% to 12% body fat(∼40 to 60 mm for International Society for the Advancement ofKinanthropometry sum of 8) and males are ∼4% to 6% body fat

109(∼30 to 40 mm International Society for the Advancement ofKinanthropometry sum of 8) in peak competition season (Fleck,1983). However, very little scientiﬁc information exists on
how to optimally implement interventions around body composition periodization throughout a given year or over a career.
A recent case study featured the body composition of an Olympiclevel female middle-distance runner throughout a 9-year
international career (Stellingwerff, 2018). During the general preparation phase, the athlete was at ∼2% to 4% over ideal competition
phase BM with optimal EA being prioritized. In the lead-up to thecompetition phase, body composition was optimized by creating
an individualized time frame and mild caloric deﬁcit (∼300 kcal).
As a result, signiﬁcant and purposeful seasonal ﬂuctuations wereobserved in anthropometric outcomes between training phases.
Importantly, the athlete only suffered two injuries over the 9-year
follow-up. Despite a strong conceptual underpinning, more researchis needed on the optimal implementation of periodized body composition strategies in short- and long-term planning.

Microperiodization (Week to Within-Day) Nutrition
Recommendations
Many elite middle-distance athletes can undertake two to three
training sessions per day (e.g., track-speciﬁc interval session,easy off track run, and weights), all of which are higher intensity;
thus, optimizing recovery (muscle glycogen and PRO resynthesis)
between sessions is a primary objective if training quality is to be
maintained. Furthermore, high-intensity training can result in appetite suppression (Hazell et al., 2016), which might impact ad libitum
caloric intake. To optimize nutrition around training and competition, athletes need to plan their days well, as some athletes will beaway from home the entire day due to school and/or work. Thus,
having portable and quickly accessible high-quality nutrition andhydration is sometimes the largest challenge facing athletes. From apractical perspective, it is important for nutrition practitioners to notjust give nutritional education/advice but also actively assess if theathlete is able to actually implement the recommendations into
their daily routines, as there can be a mismatch between nutrition
advice and athlete practice. In support of this, several recent studies
conducted primarily in a large cohort of elite middle-distanceathletes (n = 38) were surveyed on their nutritional knowledge.
Interestingly, most athletes reported to have sound recovery nutrition knowledge, as they said they focused on adequate fueling (96%)
and CHO and PRO recovery (87%) around key training sessions(Heikura et al., 2017b). However, when this same cohort of athletes
undertook 7 days of dietary recording and assessment, on average,
no males or females actually reached the recommended postworkout
PRO intake levels, and only males on hard training days reached the
CHO recovery recommendations (Heikura et al., 2017a). Therefore,
despite these athletes having decent nutrition recovery knowledge,
most athletes did not systematically follow the most recent sports
nutrition guidelines to optimize recovery.
It is beyond the scope of this review to cover the daily CHO
and PRO recommendations in depth. In terms of within-day
macronutrient microperiodization, PRO is especially important
to not only optimize acute recovery, but daily overall muscle/
body PRO synthesis and adaptation (for review see: Phillips et al.,2018). Furthermore, there is growing evidence that strategicallymanipulating acute within-day CHO availability can serve as apotent mediator in the adaptive response to endurance training, of
which the interested reader should be referred (Impey et al., 2018;
Stellingwerff et al., 2018).

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Optimizing Competition Nutrition
Most elite middle-distance athletes will race between 10 and 25
times per year with substantial traveling to meets throughout the
global IAAF circuit. Most of these meets are “one-off” races, withathletes ﬂying the day or two before the meet and leaving the day
after competition. Considerations around travel fatigue, jet lag,and racing fatigue (emotional/physical) must all be considered(Table 1).
In the weeks prior to major championships, athletes starttapering, resulting in signiﬁcantly reduced training (∼30% to60%) and exercise energy expenditure, coupled with staying inprechampionship training camps or in an athlete’s village. All of
this requires signiﬁcant travel, which brings a whole host of
associated nutritional challenges beyond the scope of this review(see Halson et al., 2018). Conversely, for some athletes entering
competition phase, race anxiety may affect their appetite cues andresult in signiﬁcantly reduced energy intake. It should be noted that
our scientiﬁc understanding of the impact of changes in acuteexercise energy expenditure (e.g., tapering) and competition anxiety on energy intake and appetite cues in athletes is poorly
understood and rife for further scientiﬁc exploration.
To optimize either race day nutrition or major championshipnutrition choices, the athlete needs to be motivated to make anindividualized plan, of which all factors for consideration arehighlighted in Table 1. Although a single race is unlikely to
exhaust fuel stores for middle-distance runners, athletes competing
many times over a championship or over the season, coupled withexcessive travel fatigue, can take a physical and emotional toll, of
which proactive and integrated nutrition planning can have a
profound recovery effect over a long race season.

Ergogenic Aids for Middle-Distance
Runners
The physiological and bioenergetic determinants of performancefor middle-distance running tend to be the focus of most training
plans as well as targets for nutritional interventions and dietary
ergogenic aid/supplementation (Figure 2, black intervention boxes).
Unfortunately, while there are countless commercially available
supplements that promise to improve performance, very few havebeen validated by scientiﬁc studies (Peeling et al., 2018). The focusof this section will therefore be on those supplements that both havean evidence-based support and second, ones that are applicable tomiddle-distance runners and published since the last consensus(Table 2).

Caffeine
Caffeine is a natural central nervous system stimulant that has
many proposed effects relevant for performance, including
improved neuromuscular function, increased alertness, andreduced fatigue and ratings of perceived exertion (RPE) during
exercise (Burke, 2008). The summary of evidence suggests thatbest practice is supplementation with 3–6 mg/kg·BM consumed∼60 min prior to exercise. However, there is also growing interestin the use of low (≤3 mg/kg BM) doses of caffeine as this may
maximize any performance-enhancing effects while simultaneously minimizing the risk of negative side effects including
anxiety, insomnia, and restlessness associated with larger doses(Spriet, 2014). In addition to traditional methods of delivery such as

coffee and caffeine capsules/tablets, there is an increasing amountof research focused on alternative delivery methods such as
caffeinated gum (Wickham & Spriet, 2018), which may also be
relevant for in-competition use. A recent systematic review (Ganio
et al., 2009) addressed the effect of caffeine on endurance performance, including 33 sport-speciﬁc trials of varying modalities andduration. In the context of middle-distance running, four of thesestudies were of a relevant duration (∼2 to 15 min) and displayed a∼1.1 ± 0.3% improvement over placebo. This is consistent withﬁndings in well-trained club-level runners (Table 2), as studies
have shown a 1–2% improvement in time-trial (TT) performanceover both 1 mile (Clarke et al., 2018) and 5,000 m (O’Rourke et al.,2008). A recent meta-analysis (Christensen et al., 2017) also founda small but meaningful (ES = 0.41, P = .002) effect of caffeine
supplementation on exercise speed in performance tests lasting
0.75 to ∼8 min. Taken altogether, the evidence suggests that
caffeine may be useful for improving performance across the entire
spectrum of middle-distance events.

Inorganic Nitrate
Nitric oxide (NO) is a potent signaling molecule that targets andaffects multiple tissues, including skeletal muscle. While NO canbe produced endogenously via NO synthases, supplementation
with inorganic nitrate in a variety of forms (the most common ofwhich are nitrate salts, beetroot juice) can also increase whole-body
NO bioavailability. In recent years, nitrate supplementation has
gained popularity due to early studies demonstrating improvements
in exercise efﬁciency (decreased O2 cost at the same absolute
workload) and a reduction the VO2 slow component (which reﬂects
a loss in muscle efﬁciency during high-intensity exercise), following both acute and chronic supplementation (reviewed in Jones,
2014). Recent work has also demonstrated that nitrate can also
improve high-intensity exercise performance, possibly due toenhanced function of Type II muscle ﬁbers (Bailey et al., 2015),
and there is a growing ﬁeld examining the effects of nitrate inunique environmental conditions such as altitude, of which manyelite middle-distance athletes implement into their programs(Shannon et al., 2017b). Given its purported exercise-related
effects, nitrate presents as an attractive candidate for enhancing
performance across all middle-distance events. A recent study
examined the effects of both acute and chronic beetroot juice
supplementation compared with a nitrate-depleted beetroot juice
placebo in elite 1,500-m runners (personal best 3 min 56 s;
VO2peak: 80 ± 5 ml·min−1·kg BM−1; Boorsma et al., 2014).
Despite large increases in plasma nitrate in both the acute andchronic trials compared with the placebo condition, submaximal
running VO2 and subsequent 1,500-m TT performance was unaffected (Table 2). In contrast, Shannon et al. (2017a) demonstrated a
1.9% improvement in 1,500-m treadmill TT performance, albeit ina less trained population (VO2: 62 ± 8 ml·min−1·kg BM−1). Overall,these ﬁndings are consistent with a number of other studies thathave failed to demonstrate an improvement in exercise economy inelite and/or well-trained athletes (Jones, 2014). Indeed, a recent
meta-analysis that included a subgroup analysis of well-trained/
elite athletes showed no signiﬁcant effect (ES = −0.04, P = .8; Van
De Walle & Vukovich, 2018), while a meta-analysis focusing on
TTs found a slight, but trivial difference (ES = 0.19, P = .09)
following nitrate supplementation compared with placebo(Christensen et al., 2017). At present, it is unclear why elite athletes
respond differently to supplementation; however, it is possible thata higher basal concentration of nitrate and nitrite and/or adaptation

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Table 1 Nutritional Challenges and Solutions Facing Elite Middle-Distance Runners Travelling and at Major
Competitions
Nutrition challenges(from least to mostimportant)
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Food choices at event/championship

Recovery during multiple
races/rounds

Race-day nutrition

Challenges

Nutrition solutions/considerations

The time for ground transportation and long-haul
ﬂights can sometimes mean 24+ hr of travel.

Individualized and optimal nutrition/hydration availability is
key. Understand the travel logistics and food options available while traveling and plan ahead to bring any food/ﬂuids
the athlete may need.
The timing of meals is an important consideration for An athlete’s eating and drinking pattern is also a zeitgeber for
travel fatigue and jet-lag symptoms.
circadian readjustment; so try to eat and drink to the new timezones meal pattern as soon as possible upon arrival (Reilly
et al., 2007).
Long-haul ﬂights are very dry and increase the risk for Remember to drink enough ﬂuids on longer ﬂights, both toathlete illness.
stay hydrated and to keep mucous moist for optimal function
and avoidance of air-borne viruses (Halson et al., 2018).
Athletes do not have direct inﬂuence on what food is Plan ahead by knowing what will be served and augmenting
served at events.
choices with one’s own food.
All you can eat buffets (e.g., Olympic Village) are
Having an individualized nutrition plan to help circumvent
often the norm and boredom and/or stress eating can this.
easily occur.
At rest days between races or at pre-championship
It has been shown that ad libitum energy intake is not
camps, the energy output is less than when in normal immediately matched by reduced energy expenditure (Stubbs
training.
et al., 2004). Therefore, athletes should microperiodize withless energy intake when not training hard or during the taper
to maintain an ideal peak body composition.
Consider potential transportation delays back to the Bring recovery products to the stadium to allow for optimal
hotel/village or an athlete being selected for a doping recovery timing. Have a clear plan for media requests andtest at the stadium or prolonged media requests that timing during the rounds of a championship.
will interfere with the optimal recovery plan.
Middle-distance runners who initiate racing with low Optimization of recovery, and speciﬁcally CHO, is fundamuscle glycogen will not perform optimallymental to race performance in later rounds of a championship.
(Maughan & Poole, 1981).
Athletes should aim for large amounts of exogenous carbohydrate (1–1.5 g·kg−1·hr−1; Jentjens & Jeukendrup, 2003)
and 0.3 g/kg of intact protein in the hours after the race
(Moore et al., 2009).
Do not let race stress/anxiety dictate over- or
Athletes should make a plan for their entire race day, that
undereating.
includes a meal plan.
Racing late in the evening.
Make a plan to implement meal timing for later evening
races; ideally practice it during training or smaller races.
Hydrate appropriate to the weather.
Racing early in the morning.
Get up ∼3 to 4 hr prior to race to allow the body to wake up
and get a carbohydrate-rich breakfast to ﬁll up the liverglycogen stores. Hydrate appropriate to the weather.
Athletes can experience stomach issues or diarrhea
Eat well-tolerated foods, and ones the athlete prefers. Stick toprior races due to nervousness.
easily digested carbohydrate and some protein-rich food.
The circuit and championships are located all over the Consider food options that are easily available worldwide.
world, with related differences in food options.
The prerace meal should be high in carbohydrates andconsumed 1–6 hr before competition.
Hydration in usual hot climates during competition
Drink enough during the day. Last 60–120 min before theseason.
warm-up athletes should aim to drink 400–600 ml water or
sports drink.
Timing of prerace snacks and ergogenic aids are
Eat last meal 1–4 hr prior the warm-up. And follow theimportant.
guidelines for caffeine, bicarbonate, or nitrate as discussed inthis paper.
Race tactics is crucial for optimal performance.
Carbohydrate intake during warm-up can give the runners
neuromuscular support via the attenuation of cognitive
fatigue that can reduce technical and tactical errors as shownin soccer players (Currell et al., 2009).
Middle-distance athletes start their warm-up more than Bring sports drink for the warm-up, as even carbohydrate
60 min before the start of the race and need to stay mouth rinsing has been shown to have performancehydrated and fueled before they get to the start line. enhancing effect (Stellingwerff & Cox, 2014).
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n = 13

n=8

n=6

n=9

n=8

Boorsma
et al. (2014)

Porcelli et al.
(2015)

Sandbakk
et al. (2015)

Shannonet al. (2017a)

Recreational club runners/
randomized, placebo-control

Junior-elite cross-country skiers/
double-blind placebo-controlled
crossoverTrained runners or triathletes/
double-blind placebo-controlled
crossoverHigh aerobic ﬁtness/double-blind
placebo-controlled crossover

Junior-elite cross-country skiers/
double-blind placebo-controlled
crossoverElite 1,500-m runners/doubleblind placebo-controlled
crossoverElite 1,500-m runners/doubleblind placebo-controlled
crossoverWell-trained club-level runners/
double-blind placebo-controlled
cross-overWell-trained club-level runners/
double-blind placebo-controlled
cross-overCohort details/study design

28 days 80-mg/kg BA vs. PLA

140-ml BRJ(12.5 mmol·NO3−) taken 3 hrprior to exercise

210-ml BRJ(19.5 mmol·NO3−) 1.5 hr prior
to exercise
Day 1, 8: 210-ml BRJ(19.5 mmol·NO3−), Day 2–7:
140-ml BRJ(13.0 mmol·NO3−) with lastdose 1.5 hr prior to exercise
500-ml water containing NO3−(∼5.5 mmol·NO3−) for 6 days,
last taken 3.5 hr prior to
exercise
1 g·KNO3− (9.9 mmol·NO3−)
taken 2.5 hr prior to exercise

800-m TT (400-m
outdoor grass track)

1,500-m TT (treadmill)

5,000-m TT (250-m
indoor track)

3,000-m TT (400-m
outdoor track)

1,500-m TT (200-m
indoor track)

1,500-m TT (200-m
indoor track)

5,000-m TT (250-m
indoor track)

1-mile TT (200-m
indoor track)∼3-mg/kg CAFF in form ofcoffee vs. DEC (0.19-mg/kg
CAFF) and PLA (hot coffeeﬂavored water) taken 60 min
prior to TT
1-g KNO3− (9.9 mmol·NO3−)
taken 2.5 hr prior to exercise

5,000-m TT (400-m
outdoor track)

Performance test

5-mg/kg CAFF vs. PLA pills
taken 60 min prior to TT

Supplement and dose

−0.36

−0.32

+1.09
−1.87*

NO3−: 250.5 ± 6.2 s
PLA: 251.4 ± 7.6 s

NO3−: 627 ± 30 s
PLA: 629 ± 28 s
NO3−: 1,016 ± 52 s
PLA: 1,005 ± 47 s
NO3−: 319.6 ± 36.2
PLA: 325.7 ± 38.8 s−0.38 vs. PLA pre−2.56 vs. BA pre*+0.12

NO3−: 250.7 ± 4.3 s
PLA: 250.4 ± 7 s

BA (pre):145.73 ± 5.71 s
BA (post):
142.09 ± 4.64 s
PLA (pre):156.80 ± 12.27 s
PLA (post):
156.21 ± 12.34 s−0.9+1.4 vs. CAFF*+2.0 vs. CAFF*−1.1*

NO3−: 1,005 ± 53 s
PLA: 996 ± 49 s

CAFF: 275 ± 11 s
DEC: 279 ± 11 s
PLA: 281 ± 10 s

CAFF: 1,047 ± 69 s
PLA: 1,058 ± 68 s

Trial result%Change(negative = fasterfor supplement)

Note. CAFF = caffeine; PLA = placebo; TT = time trial; DEC = decaf; NO3− = nitrate; KNO3− = potassium nitrate; BRJ = beetroot juice; BA = β-alanine.
*Signiﬁcantly faster than opposing treatment. No new (2007–2018) studies investigating sodium bicarbonate supplementation on middle-distance running performance in trained cohorts were found. Percent differenceswere calculated by the authors of this publication based on provided mean data.

BA supplementation
Ducker et al.
n = 18(2013)

n=8

Boorsma
et al. (2014)

NO3− supplementation
Peacock et al.
n = 10(2012)

Clarke et al.
(2018)CAFF supplementation
O’Rourken = 15et al. (2008)

Reference

Samplesize

Table 2 Summary of Recent (2007–2018) Studies Utilizing Ergogenic Aids to Improve Middle-Distance Running Performance in Trained/Elite
Cohorts

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Nutrition for Middle-Distance Athletes

to several years/decades of training negates any further effect given
via nitrate supplementation.

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β-Alanine—Intracellular Buffering
Carnosine is an intracellular dipeptide found in a variety of tissues,
including skeletal muscle, and has a variety of proposed physiological roles including acting as an intracellular buffer (Harris &Stellingwerff, 2013) and, more recently, as an intracellular shuttleof hydrogen cation (H+) and calcium (Ca2+) from the sarcoplasmic
reticulum to the actin–myosin cross-bridge locations within themuscle (Blancquaert et al., 2015; Swietach et al., 2014). Carnosine
is produced in muscle via the combination of the amino acids Lhistidine and β-alanine (BA), with dietary intake of the latter aminoacid limiting synthesis (Harris et al., 2006). High-intensity exercise
causes an accumulation of H+, which is involved in the drop of
intracellular pH from ∼7.0 to ∼6.6 (Hermansen & Osnes, 1972)
which could potentially be one of the contributing factors to fatigue(although H+ is certainly not the only reason for changes in muscle
pH and fatigue; Gladden, 2004). As such, supplementation with
BA resulting in increased muscle carnosine presents an opportunity
to increase skeletal muscle pH buffering capacity and/or shuttlingof H+ and Ca2+, thereby potentially delaying the onset of fatigue
and improving performance (Saunders et al., 2017a). Research has
demonstrated that supplementation can increase carnosine concentration equally in both Type I and Type II ﬁbers in the range of
40–80% depending on dose and timing (Stellingwerff et al., 2012).
Furthermore, recent data (Saunders et al., 2017b) demonstrate thatchronic supplementation (24 weeks with 6.4 g/day BA) can resultin further increases beyond those seen with a more typical 2- to
4-week loading period (skeletal muscle carnosine had increased by∼51% by Week 4 in contrast to the 90–95% increase seen by Weeks
20–24). Importantly, the additional increase in carnosine content at
Week 20 and 24 coincided with an increase in the likelihood of
positive improvement in time to exhaustion (ES = 0.62, 1.21, and0.83 at Weeks 4, 20, and 24, respectively). Therefore, while current
recommendations are daily consumption of ∼3 to 6 g BA for aminimum of 2–4 weeks (Saunders et al., 2017a), longer periods
may result in additional increases in skeletal muscle carnosine
content. In the context of middle-distance running performance,
athletes running 800–1,500 m are the most likely to beneﬁt fromBA supplementation, as compared with 5,000-m athletes, as arecent meta-analysis demonstrates that the strongest effect is on
exercise lasting 60–240 s (Hobson et al., 2012; Saunders et al.,2017a). This has previously been demonstrated in recreational clubrunners, as 28 days of supplementation with BA improving 800-m
running performance by 2.6% (Table 2; Ducker et al., 2013).
However, despite the well-established evidence demonstrating
the ability to increase skeletal muscle carnosine stores throughBA supplementation, the results of several meta-analyses suggestthat the effects of BA are stronger on exercise capacity tests(e.g., time to exhaustion), as opposed to speciﬁc performance tests(Christensen et al., 2017; Hobson et al., 2012; Saunders et al.,2017a). Furthermore, effects appear to be stronger in nontrained
recreationally active individuals (Saunders et al., 2017a), withsmaller, but potentially meaningful, effect sizes in well-trainedand elite athletes (possibly due to the smaller overall number ofstudies performed in this population). Consequently, it is difﬁcult
to deﬁnitively say whether BA supplementation will improve
performance in elite middle-distance athletes, given the lack ofdata in this cohort, the prevalence of nonperformance related tests
and the smaller effect sizes. However, given the absence of side113

effects and the potentially meaningful improvements in performance outlined previously, individual athletes and their support
teams may consider trialing BA supplementation to determine if it
is effective for them.

Sodium Bicarbonate—Extracellular Buffering
Sodium bicarbonate (NaHCO3−) is a key extracellular buffer, which
can improve performance by increasing extracellular bicarbonate(concentrations and blood pH. In doing so, the efﬂux of lactate andH+ cations out of skeletal muscle is increased thereby minimize
intracellular metabolic perturbations linked to fatigue (Jubrias et al.,2003). As with BA, research has typically focused on high-intensity
exercise lasting 60–360 s (800–1,500 m) where H+ accumulation anddecreases in both intra- and extracellular pH are most likely to occur.
While the timing and ingestion patterns vary greatly between studies,it has been suggested that a 5–6 mmol/L increase in blood bicarbonate
concentration is required to improve performance (Carr et al.,2011a). As a result, current guidelines suggest supplementing with
0.2–0.4 g/kg BM 60–150 min prior to exercise (Carr et al., 2011a). A
recent meta-analysis by Christensen et al. (2017) found a small but
meaningful (ES = 0.40, P < .001) effect of NaHCO3− supplementation on exercise speed in TT-based performance tests indicating it can
improve intense endurance performance. These ﬁndings are supported by other published work assessing a broader scope of performance measures and protocols demonstrating a moderate effect of
NaHCO3− on performance outcomes (ES = 0.41, P = .007), although
it is worth noting the effects were greater in untrained versus trained
participants (Peart et al., 2012). Classical work also supports use of
NaHCO3− for improving running performance, as both 800- (Wilkes
et al., 1983) and 1,500-m (Bird et al., 1995) performance was
improved in trained runners compared with placebo and control. It
is however important to note that some individuals suffer from gastrointestinal (GI) upset following supplementation with NaHCO3−,
particularly when consuming doses greater than 0.3 g/kg BM(Carr et al., 2011b) and that individuals experiencing GI upset do
not improve performance postsupplementation (Price & Simons,
2010; Saunders et al., 2014). Runners may be particularly sensitive
to these issues given the nature of the sport (upright posture and prone
to jostling of ﬂuids in the stomach), and thus, strategies such as
consuming the supplement with food (Carr et al., 2011b) may prove
beneﬁcial to minimize adverse effects. An additional concern that isof particular relevance for weight-dependent runners is the potential
for increased ﬂuid retention, and therefore an increase in BM, as aresult of the increased sodium intake (Sims et al., 2007a, 2007b).
Taken together, these ﬁndings suggest that supplementation with
NaHCO3− has the potential to improve middle-distance running
performance. Furthermore, it is possible that the overall “strength”
of the effect of NaHCO3− on subsequent performance in the previously mentioned meta-analyses may be underestimated by the
inclusion of individuals who suffer from GI issues. Supplementation
should therefore be tailored to each individual athlete to determine
susceptibility to GI upset and/or body weight gain (ﬂuid retention)and efﬁcacy of supplementation to improve performance.

Further Considerations Regarding Supplements
and Elite Middle-Distance Runners
Beyond the lack of female and/or elite subjects the relative lack ofrunning-based performance studies is also striking (Table 2), as
most studies seem to implement cycling-based interventions.
However, we would hypothesize that potentially the response of

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Stellingwerff, Bovim, and Whitﬁeld

some ergogenic aids in elite middle-distance runners may beunique from cyclists. Accordingly, given the very high neuromuscular demands (ground contact times approaching 100 ms) coupledwith a high anaerobic component (greatest acidosis [H+] of any
event), anything that might improve contractile forces/twitch
dynamics, or efﬁciency of mechanisms associated with muscle
contraction, should theoretically improve middle-distance race
performance. Therefore, alternative and emerging mechanismsof carnosine (Swietach et al., 2014) and nitrate (Coggan et al.,2018; Whitﬁeld et al., 2017) involving calcium handling, recycling, and/or shuttling, and increasing contractile force and twitch
kinetics, requires more research in elite running models, which
would notionally accentuate these performance mechanism(s)more than cycling models. Obviously, more performance andmechanistically related ergogenic aid data are required in elite
runners. The reader interested in responders versus nonresponders,combinations of ergogenic aids and ergogenic aid periodization
should see Peeling et al. (2018) and Stellingwerff et al. (2018).

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Conclusion and Future ResearchConsiderations
Given that middle-distance races are at the crossroads of metabolism, featuring both high aerobic and anaerobic ATP production,
there are numerous opportunities for various nutrition interventions
to make a signiﬁcant training and/or race performance impact.
Indeed, as an event group, middle-distance athletes might feature
the greatest polarization and diversity of training periodization
between athletes and between various training seasons, and future
nutrition studies should attempt to address this diversity. Indeed,
the ﬁber type and bioenergetics diversity in elite middle-distanceathletes requires further nutritional investigation and consideration.
Finally, more research on the impact that nutrition has in running/
structural modes of exercise, as compared with the dominate modeof cycling, needs to be addressed. Currently, given the extreme
intensities of training and racing in middle-distance athletes,
optimizing muscle glycogen contents to support high glycolyticﬂux (resulting in very high lactate values) with appropriate buffering capabilities, while optimizing power to weight ratios, all in amacro- and microperiodized manner, are the principle nutritional
interventions to emphasize.

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