Page 84 - JSOM Spring 2021

benefits for SOF personnel. Furthermore, predictors of success placebo group, during an anaerobic endurance test; however,
in Ranger school and military task performance are closely this finding was not replicated in a recent trial. 53,65
tied to muscular strength. 49,50
Recovery From Physiological Stress
Preliminary evidence in older adults suggests that FOS may be SUSOPS may require multidaily missions in the presence of ca-
an effective nutritional strategy to positively influence strength loric deficits, maneuvering under heavy loads, and sleep depriva-
outcomes with or without resistance training. 51,52 However, in tion with minimal time to recover. Muscle damage from intense
a study in athletes, Gravina et al. reported that FOS did not combat training can lead to symptoms that are relatively debili-
enhance one-rep max (1RM) strength compared to placebo. tating and, thus, detrimental to recovery. While muscle damage
53
Another study with a resistance training component, albeit in may lead to positive long-term training adaptations, the prepa-
college-aged women, reported similar results for 1RM strength ration of SOF personnel for combat, in particular, multiple mis-
outcomes. 54 sions in a short timeframe, should involve strategies to facilitate
recovery to expedite the return to optimal performance.
On the contrary, data investigating the impact of FOS on
strength preservation following muscle-damaging or intense In two systematic reviews, the clearest benefit of FOS was mus-
exercise is more comprehensive. Data shows a notable or sig- cle recovery. 14,15 Based on 13 studies, FOS, ranging from 1.8g/d
nificant effect of FOS to attenuate decrements in strength in to 6g/d and supplying greater amounts of EPA versus DHA, led
the majority but not all trials. 55–66 A recent systematic review to a combined decrease in perceived muscle soreness, greater
of 18 studies determined that FOS given for at least 3 weeks range of motion, and less muscle swelling after rigorous train-
preserved strength during stressful exercise. A recent trial ing or muscle damaging exercise. Just as striking, Lewis et
14
14
not included in the analysis reported that strength returned to al. found that four of five studies in athletes reported positive
baseline after muscle-damaging exercise in the high-dose FOS effects on multiple skeletal muscle recovery outcomes. Two
15
groups (6g/d). While this result did not reach statistical sig- recent trials, not included in the systematic reviews, reported
67
nificance, it is clinically meaningful given that no other group that FOS significantly decreased perceived muscle soreness in
reached baseline. endurance- and resistance-trained participants. 67,78
78
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Power Overall: Physical Performance
Power is a critical indicator of military performance. Ranger
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school completion and SOF task performance have been con- As illustrated in Table 2, FOS anabolic capabilities may lead
sistently associated with lower body power. 49,68 It has been to LBM accretion; however, FOS may not improve strength,
demonstrated that vertical jump (VJ) performance does not power, or endurance-related outcomes. FOS anticatabolic ef-
return to baseline after 2 weeks of recovery from Special fects are much more promising. The evidence to date suggests
Forces training. To date, only a few studies have explored that FOS likely preserves strength and power during rigorous
36
the relationship between FOS and the promotion or preser- training or physiological stress primarily by enhancing muscu-
vation of power. 53,67,69–71 Raastad et al. reported no improve- lar recovery.
ments in aerobic or anaerobic power following 10 weeks of
FOS (5.2g/d) in male soccer players. During 4 weeks of high Other SOF Relevant Scenarios
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dose FOS (~7g/d) in elite athletes, Gravina et al. reported no
improvement in VJ height; however, anaerobic power signifi- Energy Deficit
cantly improved. 53 SOF personnel often conduct SUSOPS in an energy deficit.
Based on 12 SOF training environments, Barringer et al. de-
In the context of preserving power, Jakeman et al. found that termined that the average energy expenditure was about 4,500
acute FOS attenuated the decline in two measures of the VJ by kcal/d. This amounted to an average energy deficit of 900
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5.1% and 6.2% following muscle-damaging exercise. Simi- kcals/d, assuming Operators consumed 100% of their ra-
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larly, Black et al. found that 5 weeks of FOS (2.2g EPA+DHA) tions. Large energy deficits compounded with a lack of rest
during rigorous preseason training led to a 4.9% increase in and recovery lead to an overall catabolic state characterized
VJ height compared to a 3.4% decrease in the placebo group. by the loss of muscle mass and strength. 41,80–82 Few trials have
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Most recently, VanDusseldrop et al. randomized 32 partici- reported on the impact of FOS on muscle mass and strength
pants into one of four groups comprised of varying doses of in a young, resistance-trained population during an energy
FOS (2g, 4g, and 6g) and one placebo group for 7 weeks. Af- deficit. 57,83 In a case study, an athlete consumed a 22 –30%

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ter muscle-damaging exercise, the FOS (6g) group’s VJ height energy- deficient diet supplemented with whey protein, vitamin
returned to baseline after 1 hour, while the other groups jump D, and fish oil (2g/d) for 6 weeks. After the intervention,
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performance remained suppressed until 48 hours. the athlete’s body composition improved – fat mass decreased
by 4.6% and LBM increased by 2%; strength increased by
Endurance 4%; and VJ improved by 1%. Although the author attributed
There are multiple mechanisms in which FOS may enhance the results primarily to the protein and vitamin D, FOS has
endurance performance (aerobic and anaerobic) in SOF per- been shown to augment MPS in combination with an amino
sonnel. Omega-3 PUFAs have been shown to increase mito- acid infusion. Although speculative, the increase in LBM and
44
chondrial biogenesis in humans, reduce oxygen consumption, strength may be due, in part, to the anabolic effect of FOS. In
and heart rate. 72–74 While these physiological responses may a randomized trial, subjects were assigned to either a sports
improve aerobic performance, multiple studies have reported beverage containing a fish oil or a carbohydrate placebo bev-
no effect of FOS on time to exhaustion or time trial perfor- erage twice daily, while in a 40% energy deficit for 2 weeks.
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mance. 75–77 Interestingly, Gravina et al. determined that FOS Despite the energy deficit and similar losses of LBM, strength
increased distance traveled by 203m, compared to 62m in the significantly improved in the FOS group.

80 | JSOM Volume 21, Edition 1 / Spring 2021