ROLE OF A DIETITIAN FOR

PARALYMPIC ATHLETES

Azimah Ahmad

National Sports Institute of Malaysia

MDA2013

INTRODUCTION

• The sports involved persons with physical disability has

increased dramatically and become more competitive.

• Those who excel in Paralympics Games like Olympic

Para Games, Asian Para Games had brought up the same

glory for the country

• Physical differences in disabled athletes may lead to

serious health problems and increase the risk of injuries.

• Therefore, suggested proper nutrition may be a key

component in preventing many healthy problems specific

to athletes with disability

HISTORY IN MALAYSIA

• Paralympic sport was started in 1970’s

in Malaysia.

• The early sports were basketball, table

tennis, badminton, darts and carom

• Now days, Malaysia paralympians are

competing in more than 20 sports

• Able-bodied sports in Malaysia have gained

certain recognition with current achievement in

international competition such as badminton ,

cycling , diving etc

• However, paralympic situation in Malaysia still

remains unclear to most even their achievement is

comparable to able-bodied sports

ACHIEVEMENT

• Hasihin Sanawi- Wheelchaire archery

W1/W2

– Silver: Palympic London 2012

• Mohd Ziyad Zolkefli- Shortput F20

– Bronze: Paralympic London 2012

• Siow Lee Chan

– Silver Paralympic 2008, Beijing

ACHIEVEMENT

Medal Name Games Sport Event

Bronze Perumal

Mariappan 1988 Seoul Weightlifting

Men's 57

kg

Silver Cheok Kon

Fatt

1992

Barcelona

Weightlifting

Men's 52

kg

Bronze

Mohamad

Khasseri

Othman

1992

Barcelona Athletic

Men's High

Jump B2

Bronze Perumal

Mariappan

1992

Barcelona Weightlifting

Men's 60

kg

CHALLENGES?

• Type of disabilities

– Blind, wheelchair, amputate, CP etc

• Illness/diseases

• Background of family

– Stay with family or

• Education background

– Ability to received information given

• Years of disabilities

SERVICES

EDUCATION

TRAINING PROGRAM & ADAPTATION

WEIGHT MANAGEMENT

THERAPEUTIC DIET

IMPORTANCE OF

EDUCATION

• Nutrition Knowledge & Attitude in

Athletes with Physical Disabilities

Ratmanesh et al; 2007J Athl Train. 2007 Jan-

Mar; 42(1): 99–105

• To compare the nutritional knowledge and attitudes of Iranian athletes with physical disabilities (APDs) after nutrition education

Objective

• Seventy-two APDs (42 APDs in the intervention group and 30 age-matched and sex-matched control APDs) and 10 coaches completed the study)

Subject

• IG;3hrs education with education tools

• CG received nothing Intervention

• 2 times qualitative and quantitative questionnaire; 30 days apart before and after

• 88 Likert scale and true-false questions

• 18 open-ended questions

• 13 of which were specifically designed for APDs.

• Each APD completed two 3-day food records.

Method

RESULTS & CONCLUSION

RESULTS:

• The APDs in the intervention group scored significantly higher

after nutrition education and higher than the control group on

the knowledge subscales and interest in nutrition.

• Although the nutrition knowledge score in this study was

moderate, several specific areas of deficient nutritional

knowledge were identified that are critical for the health of

APDs

Conclusions:

• Findings suggest that Iranian APDs lack nutritional knowledge

in areas critical to preventing nutrition related health problems,

especially components related to nutrition

Nutrition Knowledge & Practice Of Malaysian Paralympic Elite Athletes (Poster presentation)

Objective

• To understand the nutrition knowledge and practice among paralympic athletes

Subjects

• 44 elite paralympic athletes

Instrumentation

• Demographic

• 25 questions knowledge of nutrition and sports nutrition

• 12 questions to assess the nutrition practices (Cupisti et al, 2002)

Male

•The highest among

powerlifters (mean 52.2

± 21.4mm)

•The lowest was

wheelchair fencing

(mean = 19.3 ± 6.7mm)

Female

•The highest among

powerlifters (mean =

56.8 ± 25.5mm)

• The lowest among

wheelchair tennis

Wheelchair

Male

•The highest among

sailing (mean = 99.4 ±

65.8mm)

•The lowest among

swimming athletes (mean

= 48.7 ± 19.2mm

Female

•Not much different; the

highest (mean = 119.3 ±

56.4mm) and the lowest

(mean = 115.6 ±

22.9mm)

Non-wheelchair

RASIONAL

• Body composition profiling can help sports

scientists to monitor their training program and

performance accordingly and manage their

weight to optimize the power to weight ratio

for their respective sports.

CASE STUDY 1

• Male wheelchair athletes

• Athletic :throwers

• Kidney failure due to motorcycle accident

• 2008 : haemodialysis with one kidney

dysfunction

• 2010 : haemodialysis with both kidney

dysfunction

ANTHROPOMETRIC &

BIOCHEMICAL DATA Parameters May 2012 June 2012

Body weight (kg) 58 60.1

Triceps (mm) 5.2 (10-15th) 4.8 (10-15th)

Subscapula (mm) 6.3 6.6

Biceps (mm) 3.9 4.4

Abdominal (mm) 7.7 7.9

Arm relax (cm) 34 (>95th) 33.7 (>95th)

Arm flex (cm) 36.9 36.7

Sodium (135-145 mmol/L) 133 130

Potassium (3.5-5.0 mmol/L) 5.6 5.2

Urea (1.7 – 8.3mmo/L) 12.8 10.8

Creatinine (64-122umol/l) 531 453

Uric acid (M= 202-417umol/l) 323 320

WHAT BEEN PRESCRIBE?

• Eat inside athletes café

• Energy requirement ~1995 kcal

• Protein requirement

– Dialysis 1.3 g/kg/bw/day

– Strength athlete 1.0-1.2 g/kg bw/day

– Therefore : 1.2 g/kg bw/day

• CHO= 6g/kg bw/day

• Glucose polymer module

• Sports drink : carbohydrate beverages

• Protein supplementation: whey protein after training

CASE STUDY 2

• Wheelchair power lifting female athletes

• Body weight management due to weight

category (below 56 kg)

• Very motivated

• Able to control her diet

• Cook by herself at home

BODY COMPOSITION

ASSESSMENT

Parameter May 2008 Aug 2008

Body weight 58.5 56.5

% body fat

(Bodpod)

54.6 44.4

Fat mass (kg) 31.9 25.1

Muscle mass (kg) 29.6 31.4

WHAT BEEN PRESCRIBE?

• Menu plan hand over to café staff

• Low fat diet

• CHO -5g/kg bw/day

• Protein – 1.2g/kg bw/day

• No sports drink during training

• Food choices e.g: wholemeal bun vs croissant

• Increase fiber intake

• Cooking method; protein sources

CASE STUDY 3

• Wheelchair archery (compound) male athletes

• Chronic pressure sore

– Went for surgery once.

– New pressure sore at different place

• Pressure sore was infected before world ranking

paralympic archery competition (Bangkok) and

recovered

• Due to hot weather, dehydrate and long hour of sitting,

his sore re-infected

• Fever till 39 ⁰C. Sent to hospital, IV antibiotic. no fever

after 2 days. Back to Malaysia

• Was advised to go for surgery and referred to HUKM

WHAT BEEN PRESCRIBE?

• High protein- 1.0-1.5 g/kg bw

• Adequate water- 1000 ml vs 2000 ml

• Vitamin C food sources

• Zink food sources

ACKNOWLEDGEMENT

• Mr Goh Kok Wei

• Miss Noorfadzlina Abd Rashad

• Miss Ivy Loke Wai Theng

• Mr Qusyairi Ajmain