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Energy Expenditure during Extreme Endurance Exercise

The Giro d’Italia


Medicine & Science in Sports & Exercise: March 2019 - Volume 51 - Issue 3 - p 568–574
doi: 10.1249/MSS.0000000000001814

Purpose Little data are available on doubly labeled water (DLW) assessed total daily energy expenditure (TDEE) during extreme endurance exercise. Doubly labeled water is considered the gold standard to measure TDEE, but different calculations are being used, which may have a large impact on the results. The aim of the current study was to measure TDEE during the Giro d’Italia and apply two different calculation methods.

Methods Seven male cyclists (age, 28 ± 5 yr; body mass index, 22.1 ± 2.1 kg·m−2) completed the 24-d professional cycling race “Giro d’Italia” in which a total distance of 3445 km was covered, including 10 mountain stages. Total daily energy expenditure was measured over the entire duration of the race, with the ingestion of DLW at three different time points. To calculate TDEE and body composition, the isotope dilution space was calculated using two different techniques, the “plateau” and “intercept” technique.

Results The %fat mass at baseline was 7.8% and 16.8% with the plateau and intercept technique respectively and did not significantly change over the course of the race. Total daily energy expenditure was on average 32.3 ± 3.4 MJ·d−1 using the plateau technique versus 28.9 ± 3.2 using the intercept technique, resulting in an average physical activity level (PAL) of 4.37 ± 0.43 versus 3.91 ± 0.39, respectively. The dilution space ratio was on average 1.030 with the plateau and 1.060 with the intercept technique.

Conclusions Given that the observed dilution space ratio with the plateau technique is similar as the expected ratio from literature and the % fat mass of 7.8% is more realistic for the athletes being studied, we propose the application of the plateau rather than the intercept method, when using DLW during extreme endurance exercise.

1Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, THE NETHERLANDS; and

2Department of Human Physiology and Sports Medicine, Vrije Universiteit Brussel, Brussels, BELGIUM

Address for correspondence: Guy Plasqui, Ph.D., Department of Human Biology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; E-mail:

Submitted for publication March 2018.

Accepted for publication October 2018.

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© 2019 American College of Sports Medicine