The Athlete

Regaining Body Mass following Illness

Ideas to help you

Note: The information provided is not intended to help diagnose, cure or prevent any disease or illness. Always check with your GP before beginning a program of exercise, especially if you are recovering from illness. All advice offered assumes that the reader has fully recovered from any disease or illness and simply wishes to regain body mass lost whilst ill.

I typically deal with athletes or generally healthy members of the public who wish to increase their fitness levels, get ready for sport or improve their sports performance and so forth. As you would probably expect, most of these people are concerned with losing or maintaining their current bodyweight but there are a few who wish to put on weight. In the past I have written extensive articles regarding how to determine calorie needs, how to train for increased muscle mass and so forth but I have always pitched these articles at competitive athletes. I would like to take a look at the opposite end of the spectrum...gaining weight following illness.

Major Problems...simple solutions.

The main problems encountered by convalescents attempting to regain lost bodyweight are:

Fatigue.

Loss of appetite.

Nausea.

Disruption of regular eating patterns.

Appetite Stimulants

- Megestrol ( Megace ) 400-800 mg/day

- Dronabinol ( Marinol ) 2.5 mg PO bid

-Usually used in conjunction with anabolic steroids.

- Recommended only if weight loss is due to reduced intake.

-Megace : Weight gain is mostly fat. May lower testosterone levels, leading to impotence.

- Dronabinol: Weight gain is mostly fat.

Anabolic steroids

- Nandrolone 100-200 mg IM q 2 weeks (men) 25-100 mg IM q 2 weeks (women)

Oxandrolone 20 mg/day PO (men and women)

- Oxymetholone ( Anadrol -50): 100-150 mg/day PO, up to 300 mg/day


- High anabolic effect and low androgenic effect. Most weight gain is lean body mass.

- Safety of nandrolone in women is established by experience with treatment of post-menopausal osteoporosis.

- Oxandralone shows highest weight gain of all treatments.

- Resistance testing recommended for patients taking anabolic steroids.

Testosterone

-Androderm patch 5 mg/day

-Testoderm TTS patch 5 mg/day

-AndroGel topical 5 g/day

- Testerone enathate or testerone cypionate 200-400 mg IM q 2 weeks or 100-200 mg IM by self injection. Often start with 400 mg IM q 2 weeks and then decrease to replacement dose of 200 mg IM q 2 weeks.

- Indicated for hypogonadism with or without wasting.

- Numerous studies show improved quality of life for hypogonadal men given testosterone ( Arch Gen Psychiatry 2000;57:141).

- Testosterone is available for oral, injectable, or transdermal use. Oral compounds have been associated with liver toxicity and should be avoided; IM injections consist of an ester in oil that extends half-life to permit weekly or biweekly administration.

- Serum testosterone levels <450 ng/dL are associated with decreased libido. Drugs associated with decreased testosterone levels are megesterol, ketoconazole, and cimetidine.

- High androgenic and anabolic effect with: improved mood; increased libido, energy, appetite, and lean body mass.

- About 50% of men with AIDS have hypogonadism ( J Clin Invest 1996;81:4051). Testosterone is most effective in these cases ( N Engl J Med 1999;340:1740). Optimal results are achieved when testosterone is combined with a resistance exercise program ( JAMA 2000;283:763).

-AndroGel is a non-patch formulation that permits dose adjustment ( Med Letter 2000;42:49).

- An NIH-sponsored study showed that eugonadol men with wasting obtained increased lean body mass with testosterone (200 mg/week IM) and progressive resistance training ( Ann Intern Med 2000;133:348).

-Resistance exercise: 20 to 120 minutes/day 3x/week

Effective in increasing lean body mass; preliminary results suggest efficacy reversing the fat accumulation ascribed to PIs ( AIDS 1999;13:1373).

So, the options from Hopkins are

a) Use appetite stimulants that cause increases in weight gain from fat.

b) Use anabolics or androgens (testosterone and other testosterone derivatives AKA "steroids" to increase muscle mass.

c) Use resistance training (weights!!!) to increase lean body mass.

I am heavily in favour of option "C" as a basis for regaining lost muscle mass and general health. In addition to the use of resistance training I would also recommend simple dietary changes as follows:

1. If you have trouble with appetite then eat when you are most hungry! If you are ravenous at 6am then have a large meal at 6am. Forget the traditional "3meals a day" approach and eat whenever you want to.

2. Eat smaller meals, more frequently. The use of small liquid based feedings in between solid food meals can allow for a significant increase in caloric intake without a noticeable effect on appetite. This can be as simple as taking a glass of milk or a protein + carbohydrate drink mix (Power Protein Plus or similar) between meals or it can mean preparing 5-8 small meals per day in advance instead of 3 bigger meals.

3. Perform light cardiovascular exercise for 5 - 15 minutes before you eat. Going for a brisk walk outdoors is a classic appetite stimulant.

4. Avoid fizzy juices, caffeine, cigarettes and other environmental factors (including people and places!) that you know decrease your appetite.

5. If you don't have a problem with appetite but can't seem to gain weight then start eating by the clock. Eat every 2 - 3 hours when awake, alternating a proper meal with a smaller snack, sandwich, piece of fruit etc. Most people (whether ill or not) who have trouble gaining weight simply do not eat enough food on a daily basis and eating small amount more often is the most effective way increase total caloric intake.

So, what kind of resistance training?

Assuming there are no limiting factors such as joint pain, high blood pressure or such like then the weight training program should be build around movements that utilise several joint simultaneously through a large range of motion. This means using exercises that involve a large number of muscles at once as opposed to attempting to build up individual muscles separately - this is more time efficient and allows for shorter sessions that don't overly interfere with day to day living and it also has a greater effect on the muscles in questions. In the gym this kind of routine would be performed with free weights but if you are going to be training at home it is perfectly acceptable to begin by using your bodyweight as resistance.

A basic program to begin with...

The following is a basic program of freehand exercise that requires no equipment other than a broom stick to perform. The aim is to encourage strength gains and subsequent increases in muscle tissue without overly stressing the body. Once you become proficient with the movements you can begin to consider beginning genuine resistance training with added weight. However, for a person attempting to regain weight after illness the following routine as presented will provide a sound starting point.

The routine will be performed 3 times a week at first, with all repetitions being performed at a slow and controlled pace. The number of repetitions will be determined by your own feelings of fatigue. You should continue with each exercise until it begins to get tiring and then stop immediately. Do not push any exercises to the point where you become exhausted or pained. Over time you will attempt to increase the repetitions performed in each exercise, building up slowly and never becoming exhausted.

Free Squats.

Lunges.

Crunches.

Pushup or half push up.

Broomstick Rowing.

Toe raise.

To begin with you will do each exercise only twice i.e. you will go through the exercises one at a time and then repeat the whole sequence a second time. After a couple of weeks you can add extra sets if you feel able, performing both more repetitions per set and more sets of each exercise. After a few weeks you may find that these bodyweight exercises no longer provide a challenge or sufficient stimulus to increase muscle mass. At this point I recommend that you seek the services of a qualified instructor and get your self in to the gym.

Swimming is also great exercise activity that can improve the health of any individual. Athletes can use swimming to both increase their overall body strength while at the same time improving the cardiovascular conditioning. The low impact exercise provided by swimming is easier on the joints than other activities such as running because the body is allowed to move fluidly through the water rather than having to endure the harsh impact that hard surfaces can deliver.

Safety

Those sports enthusiasts who choose to improve their health by swimming should always do so under the supervision of a lifeguard to ensure maximum safety levels. A first aid kit should be available and in close proximity to the pool in case an accident were to occur. The proper amount of chlorine and other chemicals should be present in every pool so that bacteria and germs are killed and that swimming conditions are safe.

Cramps

A swimmer’s worst nightmare is having a cramp in the middle of the deep end of a pool. Cramps can be so debilitating that they have caused a great number of inexperienced swimmers to drown. Another great way to reduce the chances of having cramps while swimming is to make sure and include a healthy amount of potassium in an athlete’s diet.

Goggles

Goggles not only improve a swimmer’s vision but also help to protect the eyes from irritation caused by the strong chemicals found in pool water.

Flippers and Floats

Flippers and floats can be a great tool for experienced swimmers who want to work on their strokes and body positions in the water. By using these training aids, swimmers can perfect their techniques and improve their performance in the water. Experts recommend that beginning swimmers learn the fundamentals of a good swimming stroke from a professional instructor to ensure that they practice good technique in the water. Doing so will prevent injury and help improve speed and endurance.

Health Benefit

For those that live in exceptionally hot climates, swimming can be a great way to exercise while at the same time beating the heat. Water allows for more heat to be transferred away from the body which keeps an athlete cooler during exercise and can reduce the risk of heat related problems such as heat stroke.

- The Athlete.org

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