Table 4.

Nutritional and thermoregulatory considerations for para-cycling athletes.

Issue	Description	Recommendation
General Fueling	Low-intensity training, low volume	3 to 5 g CHO/kg/day
	Moderate intensity training (e.g., 1 h/d moderate to high intensity)	5 to 7 g CHO/kg/day
	High-volume and/or intensity (e.g., 1–3 h/d)	6 to 10 g CHO/kg/day
	Very high-volume, high-intensity training load (e.g., >4–5 h/d)	8 to 12 g CHO/kg/day
	Protein	1.2 to 1.8 g/kg/day
Pre Session	>60 min before the session	1 to 4 g CHO/kg (1–4 h before)
During Session	<45 min	No CHO or fluid needed
	45 to 75 min	Water or small amounts of CHO including CHO mouth wash (CHO rinse for 60 s)
	60 to 150 min	30 to 60 g CHO/h; water amount based on individual sweat rate
	>150 min	Up to 90 g CHO/h, a combination of glucose and fructose
Post Session	CHO reloading	1 to 1.2 g CHO/kg/h, for the first 4 h
	Rehydration	150% of fluid losses consumed over the next few hours, using salty snacks in the heat or with “salty sweating” athletes
	Protein (i.e., repair, muscle protein synthesis)	20 to 25 g of high-quality protein (or 0.3 to 0.5 g/kg)
Hydration	Monitor hydration status via first morning urine (e.g., urine color, USG) or via thirst	Pale urine color in the morning, USG <1.020
	Monitor pre/post-session body weight (cave: wear minimal clothing) to estimate fluid loss and sweat rate	Body mass loss <2% Avoid overdrinking (e.g., no weight gain)
Heat	Pre-cooling	Ice slurry, ice towel, cold water immersion, ice vest (60 to 20min before the exercise)
	Per-Cooling	Ice vests, ice towel, artificial sweating (e.g., water spray), menthol, cooling garments
	Sweat capacity	Sweat capacity impaired in athletes with SCI (i.e., tetraplegia) and amputees → individual strategies to pre-or per-cooling needed
	Hyperhydration	Using a salt or glycerol loading protocol to increase plasma volume (e.g., high sweat rates, salty sweater, hot conditions)

Adapted from [5,6,45,52,53] Note: CHO = carbohydrate, USG = urine specific gravity.