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Ihalainen JK, Mikkonen RS, Ackerman KE, Heikura IA, Mjøsund K, Valtonen M, Hackney AC. Beyond Menstrual Dysfunction: Does Altered Endocrine Function Caused by Problematic Low Energy Availability Impair Health and Sports Performance in Female Athletes? Sports Med 2024:10.1007/s40279-024-02065-6. [PMID: 38995599 DOI: 10.1007/s40279-024-02065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/13/2024]
Abstract
Low energy availability, particularly when problematic (i.e., prolonged and/or severe), has numerous negative consequences for health and sports performance as characterized in relative energy deficiency in sport. These consequences may be driven by disturbances in endocrine function, although scientific evidence clearly linking endocrine dysfunction to decreased sports performance and blunted or diminished training adaptations is limited. We describe how low energy availability-induced changes in sex hormones manifest as menstrual dysfunction and accompanying hormonal dysfunction in other endocrine axes that lead to adverse health outcomes, including negative bone health, impaired metabolic activity, undesired outcomes for body composition, altered immune response, problematic cardiovascular outcomes, iron deficiency, as well as impaired endurance performance and force production, all of which ultimately may influence athlete health and performance. Where identifiable menstrual dysfunction indicates hypothalamic-pituitary-ovarian axis dysfunction, concomitant disturbances in other hormonal axes and their impact on the athlete's health and sports performance must be recognized as well. Given that the margin between podium positions and "losing" in competitive sports can be very small, several important questions regarding low energy availability, endocrinology, and the mechanisms behind impaired training adaptations and sports performance have yet to be explored.
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Affiliation(s)
- Johanna K Ihalainen
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland.
- Finnish Institute of High Performance Sport KIHU, Jyväskylä, Finland.
| | - Ritva S Mikkonen
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland
- Sports Technology Unit, Faculty of Sport and Health Sciences, University of Jyväskylä, Vuokatti, Finland
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ida A Heikura
- Canadian Sport Institute-Pacific, Victoria, BC, Canada
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Katja Mjøsund
- Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
- National Olympic Training Centre Helsinki, Helsinki, Finland
| | - Maarit Valtonen
- Finnish Institute of High Performance Sport KIHU, Jyväskylä, Finland
| | - Anthony C Hackney
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Carson TL, West BT, Sonneville K, Zernicke RF, Clarke P, Harlow S, Karvonen-Gutierrez C. Identifying latent classes of Relative Energy Deficiency in Sport (RED-S) consequences in a sample of collegiate female cross country runners. Br J Sports Med 2023; 57:153-159. [PMID: 36137732 DOI: 10.1136/bjsports-2021-104083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The purpose of this study was to identify patterns of clustering of the 10 health consequences identified in the Relative Energy Deficiency in Sport (RED-S) framework among collegiate female Cross-Country runners. We also assessed risk characteristics associated with each cluster. METHODS This randomly sampled population included 211 current National Collegiate Athletics Association (NCAA) Division I (DI) female cross country runners who completed a quantitative survey. We used latent class analysis (LCA) to group athletes into mutually exclusive classes based on shared response patterns of RED-S consequences. We computed descriptive statistics to identify demographics, personal characteristics, disordered eating and emotional health characteristics associated with each class. RESULTS The average age of the sample was 21 years with mean body mass index 20.4 kg/m2. The LCA identified three unique classes of potential RED-S presentations: (1) low probability of RED-S consequences; (2) complex physical and psychological concerns with a higher burden of cardiovascular concern and (3) very high probability of anxiety with high burden of menstrual disturbance, bone injury and gastrointestinal concern. All classes were characterised by high levels of menstrual disturbance and distinguished by the number and burden of other potential RED-S consequences and in reported abuse history, emotional regulation and perfectionism. CONCLUSION This study identified a high burden of menstrual disturbance in NCAA D1 cross country runners, and three unique presentations of RED-S consequences. Future research is warranted to better understand how early prevention and intervention strategies may mitigate RED-S consequences in distance runners.
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Affiliation(s)
- Traci Lyn Carson
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Brady T West
- Institute for Social Research (ISR), University of Michigan, Ann Arbor, Michigan, USA
| | - Kendrin Sonneville
- Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Ronald F Zernicke
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Philippa Clarke
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Sioban Harlow
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Neuroendocrine Blockade of the Reproductive Axis in Female Athletes. ENDOCRINES 2022. [DOI: 10.3390/endocrines3040063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
This review aims at defining the neuroendocrine mechanisms underlying the sport-induced restrictions of the reproductive axis in female athletes. Episodic gonadotropin release was found to be compromised, presumably a result of impaired hypothalamic pulsatile GnRH release. Any deviation from optimal gonadotropin release may result in a suboptimal function of the ovaries, leading to disorders of the menstrual cycle and ovulation. A whole spectrum of menstrual dysfunctions ranging from ovulatory eumenorrhea to luteal phase defects and amenorrhea has been reported in sportive women. As essential neuroendocrine factors underlying these observations, activation of the adrenal axis and altered central nervous neurotransmitter activity have been identified to transfer metabolic, nutritional, and stress signals into the hypothalamic GnRH release. The degree by which the neuroendocrine axis governing reproduction is impaired critically depends on the intensity and duration of exercise and the state of training. Other decisive factors may be energy expenditure and availability, nutritional components, and the maturity of the hypothalamic-pituitary-ovarian (HPO) axis when sport activity was initiated. In conclusion, the gradual cessation of reproductive function observed in female athletes may be interpreted as an adaptive mechanism in response to physical and psychological endurance during sport. This sport-induced restriction of reproductive capacity may serve as protection (endogenous contraception) to preserve a woman’s health.
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Carson TL, Hazzard VM, Finn E, Lipson SK. Participation in varsity sports, dance, and Greek life associated with menstrual disturbance in a national sample of female college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:2365-2372. [PMID: 35380508 PMCID: PMC9532456 DOI: 10.1080/07448481.2020.1862852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 09/29/2020] [Accepted: 12/06/2020] [Indexed: 06/14/2023]
Abstract
Objective: The objective of this study was to identify university-sponsored activities associated with increased odds of menstrual disturbance among female college students. Participants: The sample included 3,277 female-identifying students at 12 colleges and universities participating in the Healthy Bodies Study during the 2013-2014 and 2014-2015 academic years. Methods: Crude and adjusted logistic regression models were run to report odds of any menstrual disturbance and amenorrhea (AMN) for participants in sports, dance, and Greek Life. Survey weights were used to account for response bias. Results: In the adjusted models, participation in varsity sport (OR = 1.82, CI 1.37, 2.37), dance (OR = 1.68, CI 1.37, 2.05) and Greek life (OR= 2.12, CI 0.13,0.18) was significantly associated with increased odds of menstrual disturbance, compared to non-participants. Conclusions: Findings suggest additional need for prevention and intervention programming against menstrual disturbance in varsity sports, dance, and Greek life activities.
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Affiliation(s)
- Traci L. Carson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Erin Finn
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sarah K. Lipson
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Defining the importance of stress reduction in managing cardiovascular disease - the role of exercise. Prog Cardiovasc Dis 2022; 70:84-93. [DOI: 10.1016/j.pcad.2022.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 12/14/2022]
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Marí-Sanchis A, Burgos-Balmaseda J, Hidalgo-Borrajo R. Eating disorders in sport. Update and proposal for an integrated approach. ENDOCRINOL DIAB NUTR 2022; 69:131-143. [PMID: 35256056 DOI: 10.1016/j.endien.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/24/2021] [Indexed: 06/14/2023]
Abstract
Eating disorders are a group of conditions which have a huge impact on the health and performance of athletes. The aetiology of eating disorders is multifactorial, being influenced by genetic and environmental factors, but also involving psychological factors and factors specific to the practising of sport. Eating disorders are highly prevalent in sport, particularly in disciplines involving endurance, those that have weight-categories or those where low weight is a competitive advantage and aesthetics are important. Athletes with eating disorders need to be assessed and receive early, comprehensive treatment. Close monitoring of nutritional status is vital, especially with female athletes. Prevention is crucial and plays an invaluable role in this type of disorder, but represents a significant challenge for all professionals who look after athletes. Priority needs to be given to implementing structured nutrition training programmes for the athlete and their entourage to help prevent eating disorders.
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Affiliation(s)
- Amelia Marí-Sanchis
- Servicio de Endocrinología y Nutrición, Unidad de Nutrición Clínica y Dietética, Complejo Hospitalario de Navarra (CHN), Navarra, Spain; Instituto de Investigación Sanitaria de Navarra (IdisNa), Navarra, Spain.
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Abstract
PURPOSE OF REVIEW Adolescence and young adulthood are a critical period in the life of women for optimizing long-term bone health. Young athletes lead a demanding lifestyle with increased dietary requirements to meet the robust demands of energy expenditure to maintain a state of energy balance. During a time of fast paced changes and unpredictable societal demands on young athletes, it is important to review the severe consequences of energy deficiency and options for adequate management. RECENT FINDINGS This review focuses on hormonal adaptations that occur in energy deficient female athletes that lead to menstrual irregularities and impaired bone health, increasing the risk for stress and other fractures. We also describe management strategies to mitigate the consequences of limited energy availability on bone and other outcomes. SUMMARY These strategies should help guide the management of young female athletes to prevent irreversible changes to their bone health. Identifying current knowledge should help increase awareness among medical providers, which can then be communicated to the sports community, parents, and athletes.
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Affiliation(s)
- Jacqueline Maya
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Four Weeks of 16/8 Time Restrictive Feeding in Endurance Trained Male Runners Decreases Fat Mass, without Affecting Exercise Performance. Nutrients 2021; 13:nu13092941. [PMID: 34578819 PMCID: PMC8469445 DOI: 10.3390/nu13092941] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Time restricted Feeding (TRF) is a dietary pattern utilized by endurance athletes, but there is insufficient data regarding its effects on performance and metabolism in this population. The purpose of this investigation was to examine the effects of a 16/8 TRF dietary pattern on exercise performance in trained male endurance runners. Methods: A 4-week randomized crossover intervention was used to compare an 8-h TRF to a 12-h normal diet (ND) feeding window. Exercise training and dietary intake were similar across interventions. Runners completed a dual-energy X-ray absorptiometry (DXA) scan to assess body composition, a graded treadmill running test to assess substrate utilization, and ran a 10 km time trial to assess performance. Results: There was a significant decrease in fat mass in the TRF intervention (−0.8 ± 1.3 kg with TRF (p = 0.05), vs. +0.1 ± 4.3 kg with ND), with no significant change in fat-free mass. Exercise carbon dioxide production (VCO2) and blood lactate concentration were significantly lower with the TRF intervention (p ≤ 0.02). No significant changes were seen in exercise respiratory exchange ratio or 10 km time trial performance (−00:20 ± 3:34 min:s TRF vs. −00:36 ± 2:57 min:s ND). Conclusion: This investigation demonstrated that adherence to a 4-week 16/8 TRF dietary intervention decreased fat mass and maintained fat-free mass, while not affecting running performance, in trained male endurance runners.
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Marí-Sanchis A, Burgos-Balmaseda J, Hidalgo-Borrajo R. Eating disorders in sport. Update and proposal for an integrated approach. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00125-7. [PMID: 34148864 DOI: 10.1016/j.endinu.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 11/15/2022]
Abstract
Eating disorders are a group of conditions which have a huge impact on the health and performance of athletes. The aetiology of eating disorders is multifactorial, being influenced by genetic and environmental factors, but also involving psychological factors and factors specific to the practising of sport. Eating disorders are highly prevalent in sport, particularly in disciplines involving endurance, those that have weight-categories or those where low weight is a competitive advantage and aesthetics are important. Athletes with eating disorders need to be assessed and receive early, comprehensive treatment. Close monitoring of nutritional status is vital, especially with female athletes. Prevention is crucial and plays an invaluable role in this type of disorder, but represents a significant challenge for all professionals who look after athletes. Priority needs to be given to implementing structured nutrition training programmes for the athlete and their entourage to help prevent eating disorders.
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Affiliation(s)
- Amelia Marí-Sanchis
- Servicio de Endocrinología y Nutrición, Unidad de Nutrición Clínica y Dietética, Complejo Hospitalario de Navarra (CHN), Navarra, España; Instituto de Investigación Sanitaria de Navarra (IdisNa), Navarra, España.
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Dziembowska I, Wójcik M, Hołyńska-Iwan I, Litwic-Kaminska K, Słomka A, Żekanowska E. Female Volleyball Players Are More Prone to Cortisol Anticipatory Stress Response than Sedentary Women. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:medicina55060258. [PMID: 31181812 PMCID: PMC6631902 DOI: 10.3390/medicina55060258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/04/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
Abstract
Background and Objectives: Top-level sports performance places heavy physical and psychological demands on elite-level athletes, which can be a source of increased levels of stress. Therefore, high-level volleyball players may present altered cardiovascular and endocrinological stress response during stressful events. Although many previous studies have examined the response to stress on athletes, most of them regarded only males, while the impact of the female menstrual cycle has rarely been taken into account. We aimed to study psychophysiological response to anticipatory stressor through analysis of heart rate, self-reported anxiety level, and salivary cortisol in healthy young female athletes by minimalizing the effect of confounders. Materials and Methods: A total of 55 females (25 members of the best league for female volleyball players in Poland and 30 sedentary-lifestyle control subjects) in the follicular phase of their menstrual cycle were exposed to mental arithmetic tasks as an experimental imitation of the stressor. Volleyball players were significantly taller than sedentary individuals (177.1 ± 3.4 cm vs. 173.3 ± 3.4 cm, respectively, p = 0.034), but did not differ in weight (73.6 ± 5.2 kg vs. 70 ± 4.23 kg, respectively, p = 0.081), body mass index (BMI) (23.5 ± 1.13 vs. 24.1 ± 1.45, respectively, p = 0.060), and age (22 ± 1.11 vs. 23 ± 1.14 years, respectively, p = 0.2). Their stress responses were assessed through self-reported anxiety levels and physiological measurements of salivary cortisol concentrations and heart rate (HR). Results: For HR, significant effects of time (F(2,120) = 21.34, p < 0.001, η2 = 0.26) were found, but not for training status (F(1,60) = 2.69, p = 0.106, η2 = 0.04). For cortisol levels, the analysis showed the main effects of time (F(3,180) = 11.73, p < 0.001, η2 = 0.16) and training status (F(1,60) = 4.69, p = 0.034, η2 = 0.07) and a significant interaction between training status and time (F(3,180) = 3.07, p = 0.029, η2 = 0.05). Post-hoc analyses showed higher cortisol concentrations among volleyball players following the math task (all p < 0.001), as well as higher cortisol concentrations in S2, S3, and S4 compared to S1 in volleyball players (all p < 0.001). We observed also a significant increase in state anxiety in both groups (all p < 0.001), but no differences in state anxiety levels between groups. Conclusion: Female volleyball players may not differ in subjective graduation of stressors; however, exposure to training-based stressors seems to promote cortisol response to the anticipated stressor.
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Affiliation(s)
- Inga Dziembowska
- Department of Pathophysiology, Faculty of Pharmacy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
| | - Małgorzata Wójcik
- Department of Physiotherapy, Stanisław Staszic University of Applied Science in Piła, Podchorążych 10, 64-920 Piła, Poland.
| | - Iga Hołyńska-Iwan
- Department of Pathobiochemistry and Clinical Chemistry, Faculty of Pharmacy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
| | - Kamila Litwic-Kaminska
- Institute of Psychology, Kazimierz Wielki University in Bydgoszcz, Staffa 1, 85-867 Bydgoszcz, Poland.
| | - Artur Słomka
- Department of Pathophysiology, Faculty of Pharmacy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
| | - Ewa Żekanowska
- Department of Pathophysiology, Faculty of Pharmacy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
- Department of Physiotherapy, Stanisław Staszic University of Applied Science in Piła, Podchorążych 10, 64-920 Piła, Poland.
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Hebebrand J, Milos G, Wabitsch M, Teufel M, Führer D, Bühlmeier J, Libuda L, Ludwig C, Antel J. Clinical Trials Required to Assess Potential Benefits and Side Effects of Treatment of Patients With Anorexia Nervosa With Recombinant Human Leptin. Front Psychol 2019; 10:769. [PMID: 31156489 PMCID: PMC6533856 DOI: 10.3389/fpsyg.2019.00769] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/20/2019] [Indexed: 12/16/2022] Open
Abstract
The core phenotype of anorexia nervosa (AN) comprises the age and stage dependent intertwining of both its primary and secondary (i.e., starvation induced) somatic and mental symptoms. Hypoleptinemia acts as a key trigger for the adaptation to starvation by affecting diverse brain regions including the reward system and by induction of alterations of the hypothalamus-pituitary-“target-organ” axes, e.g., resulting in amenorrhea as a characteristic symptom of AN. Particularly, the rat model activity-based anorexia (ABA) convincingly demonstrates the pivotal role of hypoleptinemia in the development of starvation-induced hyperactivity. STAT3 signaling in dopaminergic neurons in the ventral tegmental area (VTA) plays a crucial role in the transmission of the leptin signal in ABA. In patients with AN, an inverted U-shaped relationship has been observed between their serum leptin levels and physical activity. Albeit obese and therewith of a very different phenotype, humans diagnosed with rare congenital leptin deficiency have starvation like symptoms including hypothalamic amenorrhea in females. Over the past 20 years, such patients have been successfully treated with recombinant human (rh) leptin (metreleptin) within a compassionate use program. The extreme hunger of these patients subsides within hours upon initiation of treatment; substantial weight loss and menarche in females ensue after medium term treatment. In contrast, metreleptin had little effect in patients with multifactorial obesity. Small clinical trials have been conducted for hypothalamic amenorrhea and to increase bone mineral density, in which metreleptin proved beneficial. Up to now, metreleptin has not yet been used to treat patients with AN. Metreleptin has been approved by the FDA under strict regulations solely for the treatment of generalized lipodystrophy. The recent approval by the EMA may offer, for the first time, the possibility to treat extremely hyperactive patients with AN off-label. Furthermore, a potential dissection of hypoleptinemia-induced AN symptoms from the primary cognitions and behaviors of these patients could ensue. Accordingly, the aim of this article is to review the current state of the art of leptin in relation to AN to provide the theoretical basis for the initiation of clinical trials for treatment of this eating disorder.
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Affiliation(s)
- Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Gabriella Milos
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zürich, Zurich, Switzerland
| | - Martin Wabitsch
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Hospital, Ulm, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dagmar Führer
- Department of Endocrinology and Metabolism, Medical Center and Central Laboratory, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Judith Bühlmeier
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lars Libuda
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christine Ludwig
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jochen Antel
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Holtzman B, Ackerman KE. Measurement, Determinants, and Implications of Energy Intake in Athletes. Nutrients 2019; 11:E665. [PMID: 30893893 PMCID: PMC6472042 DOI: 10.3390/nu11030665] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/09/2019] [Accepted: 03/15/2019] [Indexed: 12/28/2022] Open
Abstract
Appropriate energy intake is important for the health and performance of athletes. When an athlete's energy intake is not concordant with energy expenditure, short- and long-term performance can be compromised and negative health effects may arise. The energy intake patterns of athletes are subject to numerous effectors, including exercise response, time, and availability of food. To assess different determinants of energy intake in athletes, we reviewed recent literature regarding the response of appetite-regulating hormones to exercise, appetite perceptions following exercise, chronic exercise-induced adaptations regarding appetite, and social factors regarding energy intake. Additionally, we discussed consequences of aberrant energy intake. The purpose of this review is to clarify understanding about energy intake in athletes and provide insights into methods toward maintaining proper energy intake.
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Affiliation(s)
- Bryan Holtzman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
- Female Athlete Program, Division of Sports Medicine and Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Kathryn E Ackerman
- Female Athlete Program, Division of Sports Medicine and Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA.
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA.
- Harvard Medical School, Boston, MA 02115, USA.
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Acute Response to Endurance Exercise Stress: Focus on Catabolic/anabolic Interplay Between Cortisol, Testosterone, and Sex Hormone Binding Globulin in Professional Athletes. J Med Biochem 2019; 38:6-12. [PMID: 30820178 PMCID: PMC6298450 DOI: 10.2478/jomb-2018-0016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/21/2018] [Indexed: 11/21/2022] Open
Abstract
Background Endocrine system plays a major role in both permissive and regulatory activities in order to adequately respond to physical stress of exercise. But level and direction of activation depend on many factors and are not easily interpreted. Methods We tested a group of male professional athletes (21 water polo players and 15 wrestlers), together with 20 sedentary controls matched by age. All participants took a continuous progressive exercise stress test on a treadmill until exhaustion and plateau of oxygen consumption (VO2). Blood samples for cortisol, sex hormone binding globulin (SHBG) and testosterone were drawn in four time points: baseline (B), start of the test (S), point of maximal strain (MAX) and in the 3rd minute of recovery period (R). Results Cortisol levels significantly increased in both groups, but the response between S and MAX was more pronounced in controls (p=0.036). The athletes had significantly higher levels of cortisol in all points in test, except during R (p=0.118), when their cortisol levels gradually started to decline. Significant increase in total testosterone was in great deal a consequence of increase in SHBG level (p<0.01 for both). Consequently, calculated free testosterone significantly decreased during test (p=0.008), and the drop was more pronounced in athletes. This was in concordance with significant correlation between SHBG and cortisol level demonstrated in athletes, but not in controls. Conclusions It seems that high intensity endurance exercise favors catabolic response, but the level of response highly depends on a previous level of training.
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Khajehnasiri N, Khazali H, Sheikhzadeh F. Various responses of male pituitary-gonadal axis to different intensities of long-term exercise: Role of expression of KNDYrelated genes. J Biosci 2018; 43:569-574. [PMID: 30207304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The essential role of regular physical activity has been emphasized for maintaining a healthy life. However, unfortunately, during the last few decades, the lifestyle of people has led to a decrease in physical activity. Research studies have shown that exercise of different intensities is applied on reproductive performance indices, luteinizing hormone (LH) and testosterone (T), with different effects. Nevertheless, the molecular and cellular mechanisms underlying its function are not completely understood. Therefore, this study aimed to evaluate the role of kisspeptin, neurokinin-B and pro-dynorphin (KNDY) gene-expression changes located in the upstream of GnRH neurons in transferring the effects of different long-term exercise intensities on male reproductive axis. Twenty-one adult Wistar rats were randomly divided into control, 6-month regular moderate exercise (RME-6) and 6-month regular intensive exercise (RIE-6). In moderate and intensive exercise groups, rats were treated 5 days a week for 60 min, at 22 and 35 m/min, respectively. Finally, the hypothalamic arcuate nucleus was isolated and the relative gene expression of kisspeptin (Kiss1), neurokinin-B (Nkb), pro-dynorphin (Pdyn) and gonadotropin-releasing hormone (Gnrh) genes were measured by realtime polymerase chain reaction method. The results showed that RIE-6 treatment decreased Gnrh and increased Pdyn mRNA levels in the arcuate nucleus. Furthermore, although RME-6 treatment decreased Nkb and increased Pdyn mRNA levels, the Gnrh mRNAwas not affected. Regarding the Gnrh mRNA levels and serum concentrations of reproductive indices (LH and T), moderate exercise did not impose harmful effects on the hypothalamic-pituitary-gonadal axis than intensive exercise. The different impacts of diverse long-term exercise intensities on the male pituitary-gonadal axis maybe relay by the various changes in hypothalamic Nkb and Pdyn gene expressions.
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Affiliation(s)
- Nazli Khajehnasiri
- Department of Animal Sciences and Biotechnology, Faculty of Biological Sciences and Technology, Shahid Beheshti University, Tehran, Iran
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Khajehnasiri N, Khazali H, Sheikhzadeh F. Various responses of male pituitary–gonadal axis to different intensities of long-term exercise: Role of expression of KNDY-related genes. J Biosci 2018. [DOI: 10.1007/s12038-018-9782-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
The term Relative Energy Deficiency in Sport was introduced by the International Olympic Committee in 2014. It refers to the potential health and performance consequences of inadequate energy for sport, emphasizing that there are consequences of low energy availability (EA; typically defined as <30 kcal·kg-1 fat-free mass·day-1) beyond the important and well-established female athlete triad, and that low EA affects populations other than women. As the prevalence and consequences of Relative Energy Deficiency in Sport become more apparent, it is important to understand the current knowledge of the hormonal changes that occur with decreased EA. This paper highlights endocrine changes that have been observed in female and male athletes with low EA. Where studies are not available in athletes, results of studies in low EA states, such as anorexia nervosa, are included. Dietary intake/appetite-regulating hormones, insulin and other glucose-regulating hormones, growth hormone and insulin-like growth factor 1, thyroid hormones, cortisol, and gonadal hormones are all discussed. The effects of low EA on body composition, metabolic rate, and bone in female and male athletes are presented, and we identify future directions to address knowledge gaps specific to athletes.
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Richard N, Palmer C, Adams HP. Female Athlete Triad. PHYSICIAN ASSISTANT CLINICS 2018. [DOI: 10.1016/j.cpha.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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International Olympic Committee (IOC) Consensus Statement on Relative Energy Deficiency in Sport (RED-S): 2018 Update. Int J Sport Nutr Exerc Metab 2018; 28:316-331. [PMID: 29771168 DOI: 10.1123/ijsnem.2018-0136] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, Lebrun C, Lundy B, Melin AK, Meyer NL, Sherman RT, Tenforde AS, Klungland Torstveit M, Budgett R. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med 2018; 52:687-697. [DOI: 10.1136/bjsports-2018-099193] [Citation(s) in RCA: 345] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 01/20/2023]
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Rizzone KH, Ackerman KE, Roos KG, Dompier TP, Kerr ZY. The Epidemiology of Stress Fractures in Collegiate Student-Athletes, 2004-2005 Through 2013-2014 Academic Years. J Athl Train 2017; 52:966-975. [PMID: 28937802 DOI: 10.4085/1062-6050-52.8.01] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Stress fractures are injuries caused by cumulative, repetitive stress that leads to abnormal bone remodeling. Specific populations, including female athletes and endurance athletes, are at higher risk than the general athletic population. Whereas more than 460 000 individuals participate in collegiate athletics in the United States, no large study has been conducted to determine the incidence of stress fractures in collegiate athletes. OBJECTIVE To assess the incidence of stress fractures in National Collegiate Athletic Association (NCAA) athletes and investigate rates and patterns overall and by sport. DESIGN Descriptive epidemiology study. SETTING National Collegiate Athletic Association institutions. PATIENTS OR OTHER PARTICIPANTS National Collegiate Athletic Association athletes. MAIN OUTCOME MEASURE(S) Data were analyzed from the NCAA Injury Surveillance Program for the academic years 2004-2005 through 2013-2014. We calculated rates and rate ratios (RRs) with 95% confidence intervals (CIs). RESULTS A total of 671 stress fractures were reported over 11 778 145 athlete-exposures (AEs) for an overall injury rate of 5.70 per 100 000 AEs. The sports with the highest rates of stress fractures were women's cross-country ( 28.59/100 000 AEs), women's gymnastics ( 25.58/100 000 AEs), and women's outdoor track ( 22.26/100 000 AEs). Among sex-comparable sports (baseball/softball, basketball, cross-country, ice hockey, lacrosse, soccer, swimming and diving, tennis, indoor track, and outdoor track), stress fracture rates were higher in women (9.13/100 000 AEs) than in men (4.44/100 000 AEs; RR = 2.06; 95% CI = 1.71, 2.47). Overall, stress fracture rates for these NCAA athletes were higher in the preseason (7.30/100 000 AEs) than in the regular season (5.12/100 000 AEs; RR = 1.43; 95% CI = 1.22, 1.67). The metatarsals (n = 254, 37.9%), tibia (n = 147, 21.9%), and lower back/lumbar spine/pelvis (n = 81, 12.1%) were the most common locations of injury. Overall, 21.5% (n = 144) of stress fractures were recurrent injuries, and 20.7% (n = 139) were season-ending injuries. CONCLUSIONS Women experienced stress fractures at higher rates than men, more often in the preseason, and predominantly in the foot and lower leg. Researchers should continue to investigate biological and biomechanical risk factors for these injuries as well as prevention interventions.
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Affiliation(s)
- Katherine H Rizzone
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, NY
| | | | - Karen G Roos
- Department of Kinesiology, California State University, Long Beach
| | - Thomas P Dompier
- Department of Athletic Training, Lebanon Valley College, Annville, PA
| | - Zachary Y Kerr
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
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Haslacher H, Ratzinger F, Perkmann T, Batmyagmar D, Nistler S, Scherzer TM, Ponocny-Seliger E, Pilger A, Gerner M, Scheichenberger V, Kundi M, Endler G, Wagner OF, Winker R. A combination of routine blood analytes predicts fitness decrement in elderly endurance athletes. PLoS One 2017; 12:e0177174. [PMID: 28475643 PMCID: PMC5419574 DOI: 10.1371/journal.pone.0177174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 04/24/2017] [Indexed: 12/18/2022] Open
Abstract
Endurance sports are enjoying greater popularity, particularly among new target groups such as the elderly. Predictors of future physical capacities providing a basis for training adaptations are in high demand. We therefore aimed to estimate the future physical performance of elderly marathoners (runners/bicyclists) using a set of easily accessible standard laboratory parameters. To this end, 47 elderly marathon athletes underwent physical examinations including bicycle ergometry and a blood draw at baseline and after a three-year follow-up period. In order to compile a statistical model containing baseline laboratory results allowing prediction of follow-up ergometry performance, the cohort was subgrouped into a model training (n = 25) and a test sample (n = 22). The model containing significant predictors in univariate analysis (alanine aminotransferase, urea, folic acid, myeloperoxidase and total cholesterol) presented with high statistical significance and excellent goodness of fit (R2 = 0.789, ROC-AUC = 0.951±0.050) in the model training sample and was validated in the test sample (ROC-AUC = 0.786±0.098). Our results suggest that standard laboratory parameters could be particularly useful for predicting future physical capacity in elderly marathoners. It hence merits further research whether these conclusions can be translated to other disciplines or age groups.
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Affiliation(s)
- Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Franz Ratzinger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Sonja Nistler
- Health and Prevention Center, Sanatorium Hera, Vienna, Austria
| | | | | | - Alexander Pilger
- Institute of Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Marlene Gerner
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Michael Kundi
- Department of Public Health, Medical University of Vienna, Vienna, Austria
| | | | - Oswald F. Wagner
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Robert Winker
- Health and Prevention Center, Sanatorium Hera, Vienna, Austria
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