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Magraner JMPDS, Talarico Neto T, Hahns Júnior HC, Tourinho Filho H, Martinelli Júnior CE. Serum Hormone Concentrations and Body Composition in Brazilian Air Force Cadets During Rainforest Survival Training. Mil Med 2023; 188:3302-3308. [PMID: 35803739 DOI: 10.1093/milmed/usac201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physiological adaptations in military jungle survival training have not yet been studied. Knowledge about the relationship between the insulin-like growth factor type I (IGF-I)/insulin-like growth factor binding protein type 3 (IGFBP-3) system and survival activities in a jungle environment can improve readiness and prepare Brazilian Air Force cadets for this kind of battlefield. Our goal was to assess changes in body composition and serum concentrations of the IGF-I/IGFBP-3 system in Brazilian Air Force cadets during five-day Amazon rainforest survival training and whether differences in sex influence these variations. METHODS In the five-day survival training, variations in body composition and serum levels of IGF-I and IGFBP-3 were observed. The sample consisted of 14 male cadets (21.71 ± 1.64 years) and 6 female cadets (22.00 ± 1.41 years). Changes were assessed before and immediately after the survival training. RESULTS The male cadets' body mass (pre: 73.89 ± 8.79 kg; post: 69.57 ± 8.44 kg), body fat (pre: 11.43 ± 4.15%; post: 10.16 ± 4.19%), IGF-I serum concentrations (pre: 252 ± 72 ng/mL; post: 140 ± 42 ng/mL), and IGFBP-3 serum concentrations (pre: 4.90 ± 0.67 ng/mL; post: 4.22 ± 0.73 ng/mL) were significantly reduced (P < .01). In the female cadets, the mean body mass values (pre: 60.98 ± 8.82 kg; post: 57.91 ± 9.01 kg), body fat (pre: 19.20 ± 5.03%; post: 17.19 ± 4.77%), and IGF-I serum concentrations (pre: 202 ± 50 ng/mL; post: 108 ± 29 ng/mL) also decreased significantly (P < .01) after survival training. Finally, the cadet's sex does not affect the variations of IGF-I (P = .46) and IGFBP-3 (P = .205) serum concentrations. CONCLUSIONS These findings all suggest that changes in body mass and body fat, as well as variations in the IGF-I/IGFBP-3 system, corroborate the need for military readiness preparation. Equivalent changes in both sexes indicate probable equal recovery intervals after survival training.
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Affiliation(s)
- José Maurício Paixão Dos Santos Magraner
- Physical Education Faculty, State University of Campinas-UNICAMP, Cidade Universitária Zeferino Vaz-Barão Geraldo, Campinas-SP 13083-970, Brazil
- State University of Campinas-FEF/UNICAMP, Cidade Universitária Zeferino Vaz-Barão Geraldo, Campinas-SP 13083-970, Brazil
| | - Thomaz Talarico Neto
- School of Physical Education and Sport of Ribeirao Preto-EEFERP/USP, University of Sao Paulo-USP, Ribeirão Preto-SP 14049-900, Brazil
| | - Higino Carlos Hahns Júnior
- School of Physical Education and Sport of Ribeirao Preto-EEFERP/USP, University of Sao Paulo-USP, Ribeirão Preto-SP 14049-900, Brazil
| | - Hugo Tourinho Filho
- School of Physical Education and Sport of Ribeirao Preto-EEFERP/USP, University of Sao Paulo-USP, Ribeirão Preto-SP 14049-900, Brazil
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Greeves JP, Beck B, Nindl BC, O'Leary TJ. Current risks factors and emerging biomarkers for bone stress injuries in military personnel. J Sci Med Sport 2023:S1440-2440(23)00075-0. [PMID: 37188615 DOI: 10.1016/j.jsams.2023.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Bone stress injuries (BSIs) have plagued the military for over 150 years; they afflict around 5 to 10% of military recruits, more so in women, and continue to place a medical and financial burden on defence. While the tibia generally adapts to the rigours of basic military training, the putative mechanisms for bone maladaptation are still unclear. METHODS This paper provides a review of the published literature on current risk factors and emerging biomarkers for BSIs in military personnel; the potential for biochemical markers of bone metabolism to monitor the response to military training; and, the association of novel biochemical 'exerkines' with bone health. RESULTS The primary risk factor for BSI in military (and athletic) populations is too much training, too soon. Appropriate physical preparation before training will likely be most protective, but routine biomarkers will not yet identify those at risk. Nutritional interventions will support a bone anabolic response to training, but exposure to stress, sleep loss, and medication is likely harmful to bone. Monitoring physiology using wearables-ovulation, sleep and stress-offer potential to inform prevention strategies. CONCLUSIONS The risk factors for BSIs are well described, but their aetiology is very complex particularly in the multi-stressor military environment. Our understanding of the skeletal responses to military training is improving as technology advances, and potential biomarkers are constantly emerging, but sophisticated and integrated approaches to prevention of BSI are warranted.
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Affiliation(s)
- Julie P Greeves
- Army Health and Performance Research, Army HQ, Andover, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom; Division of Surgery and Interventional Science, UCL, United Kingdom.
| | - Belinda Beck
- School of Health Sciences and Social Work, Griffith University, Australia; The Bone Clinic, Australia.
| | - Bradley C Nindl
- School of Health and Rehabilitation Sciences, University of Pittsburgh, United States.
| | - Thomas J O'Leary
- Army Health and Performance Research, Army HQ, Andover, United Kingdom; Division of Surgery and Interventional Science, UCL, United Kingdom.
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Abbott A, Wang C, Stamm M, Mulcahey MK. Part II: Risk Factors for Stress Fractures in Female Military Recruits. Mil Med 2023; 188:93-99. [PMID: 35253041 DOI: 10.1093/milmed/usac033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Stress fractures (SFx) represent a significant proportion of injuries in military recruits internationally. Stress fractures disproportionately affect female recruits, a disparity that has similarly been consistently demonstrated in female athletes. Stress fractures result in medical morbidity, financial burden, and medical discharge from military service. This review presents current literature regarding SFx risk factors to identify and/or mitigate in this high-risk population. METHODS A literature review was conducted using PubMed to find relevant articles. We utilized keywords stress fracture, military, recruits, female, risk factors, modifiable, non-modifiable, overuse, nutrition, and/or prevention. Articles older than 10 years (published before 2010) were not considered. Review articles were considered, but if a research article was cited by a review, the research was included directly. Articles with primary military data, members of the military as subjects, especially when female recruits were included, were strongly considered for inclusion in this review. RESULTS Modifiable risk factors for SFx include nutritional deficiency, especially of iron, vitamin D, and possibly calcium, poor physical fitness, suboptimal training programming for injury development and recovery, load carriage, and military footwear. Non-modifiable risk factors include female sex, greater height, lower weight and body mass index in females but lower or higher weight and body mass index in males, lower body fat percentage, and lower bone mineral density. In addition, menstrual dysfunction, low energy availability, later age at menarche, and iron deficiency pose unique risks to female recruits. Preventive measures include leadership education, programs with recovery considerations, and risk factor screening. CONCLUSION This review, Part II of a two-part series, guides multidisciplinary management of military recruits, especially females, who are at risk for developing SFx. Unique nuances of the military recruit require specific knowledge to reduce high incidence rates of injury internationally.
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Affiliation(s)
- Alexandra Abbott
- Department of Pediatrics, University of California, Los Angeles, CA 90095, USA
| | - Cindy Wang
- Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Michaela Stamm
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA 70118, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA 70118, USA
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Costa TMDRL, Borba VZC, Correa RGP, Moreira CA. Stress fractures. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:765-773. [PMID: 36382766 PMCID: PMC10118812 DOI: 10.20945/2359-3997000000562] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Stress fractures (SF) represent 10%-20% of all injuries in sport medicine. An SF occurs when abnormal and repetitive loading is applied on normal bone: The body cannot adapt quickly enough, leading to microdamage and fracture. The etiology is multifactorial with numerous risk factors involved. Diagnosis of SF can be achieved by identifying intrinsic and extrinsic factors, obtaining a good history, performing a physical exam, and ordering laboratory and imaging studies (magnetic resonance imaging is the current gold standard). Relative energy deficiency in sport (RED-S) is a known risk factor. In addition, for women, it is very important know the menstrual status to identify long periods of amenorrhea in the past and the present. Early detection is important to improve the chance of symptom resolution with conservative treatment. Common presentation involves complaints of localized pain, with or without swelling, and tenderness on palpation of bony structures that begins earlier in training and progressively worsens with activity over a 2- to 3-week period. Appropriate classification of SF based on type, location, grading, and low or high risk is critical in guiding treatment strategies and influencing the time to return to sport. Stress injuries at low-risk sites are typically managed conservatively. Studies have suggested that calcium and vitamin D supplementation might be helpful. Moreover, other treatment regimens are not well established. Understanding better the pathophysiology of SFs and the potential utility of current and future bone-active therapeutics may well yield approaches that could treat SFs more effectively.
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Costache AD, Costache II, Miftode RȘ, Stafie CS, Leon-Constantin MM, Roca M, Drugescu A, Popa DM, Mitu O, Mitu I, Miftode LI, Iliescu D, Honceriu C, Mitu F. Beyond the Finish Line: The Impact and Dynamics of Biomarkers in Physical Exercise-A Narrative Review. J Clin Med 2021; 10:jcm10214978. [PMID: 34768497 PMCID: PMC8584497 DOI: 10.3390/jcm10214978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/14/2022] Open
Abstract
The research of biomarkers continues to emerge as a developing academic field which is attracting substantial interest. The study of biomarkers proves to be useful in developing and implementing new screening methods for a wide variety of diseases including in the sports area, whether for leisure activities or professional sports. Novel research has brought into question the immune system and the limitations it may impose on sports practicing. As the well-being of athletes is a priority, the state of their immune function offers valuable information regarding their health status and their ability to continue training. The assessment of various biomarkers may contribute to a more accurate risk stratification and subsequent prevention of some invalidating or even fatal pathologies such as the sudden cardiac death. Therefore, we have reviewed several studies that included sports-related pathology or specific morphofunctional alterations for which some immune biomarkers may represent an expression of the underlying mechanism. These include the defensins, immunoglobulin A (IgA), interleukin-6 (IL-6), the tumoral necrosis factor α (TNF-α), and the white blood cells (WBC) count. Similarly, also of significant interest are various endocrine biomarkers, such as cortisol and testosterone, as well as anabolic or catabolic markers, respectively. Literature data highlight that these values are greatly influenced not only by the duration, but also by the intensity of the physical exercise; moderate training sessions actually enhance the immune function of the body, while a significant increase in both duration and intensity of sports activity acts as a deleterious factor. Therefore, in this paper we aim to highlight the importance of biomarkers’ evaluation in connection with sports activities and a subsequent more adequate approach towards personalized training regimens.
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Affiliation(s)
- Alexandru-Dan Costache
- Department of Cardiovascular Rehabilitation, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (M.-M.L.-C.); (M.R.); (A.D.); (F.M.)
| | - Irina-Iuliana Costache
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-I.C.); (D.-M.P.); (O.M.); (D.I.)
| | - Radu-Ștefan Miftode
- Department of Cardiovascular Rehabilitation, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (M.-M.L.-C.); (M.R.); (A.D.); (F.M.)
- Correspondence:
| | - Celina-Silvia Stafie
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Maria-Magdalena Leon-Constantin
- Department of Cardiovascular Rehabilitation, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (M.-M.L.-C.); (M.R.); (A.D.); (F.M.)
| | - Mihai Roca
- Department of Cardiovascular Rehabilitation, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (M.-M.L.-C.); (M.R.); (A.D.); (F.M.)
| | - Andrei Drugescu
- Department of Cardiovascular Rehabilitation, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (M.-M.L.-C.); (M.R.); (A.D.); (F.M.)
| | - Delia-Melania Popa
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-I.C.); (D.-M.P.); (O.M.); (D.I.)
| | - Ovidiu Mitu
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-I.C.); (D.-M.P.); (O.M.); (D.I.)
| | - Ivona Mitu
- Department of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Larisa-Ionela Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Dan Iliescu
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-I.C.); (D.-M.P.); (O.M.); (D.I.)
| | - Cezar Honceriu
- Faculty of Physical Education and Sports, “Alexandru Ioan Cuza” University, 700115 Iasi, Romania;
| | - Florin Mitu
- Department of Cardiovascular Rehabilitation, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (M.-M.L.-C.); (M.R.); (A.D.); (F.M.)
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Wardle SL, O'Leary TJ, McClung JP, Pasiakos SM, Greeves JP. Feeding female soldiers: Consideration of sex-specific nutrition recommendations to optimise the health and performance of military personnel. J Sci Med Sport 2021; 24:995-1001. [PMID: 34452842 DOI: 10.1016/j.jsams.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 06/25/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
Appropriate nutrition recommendations are required to optimise the health and performance of military personnel, yet limited data are available on whether male and female military personnel have different nutrition requirements. OBJECTIVES To consider the evidence for sex-specific nutrition requirements to optimise the health and performance of military personnel. DESIGN Narrative review. METHODS Published literature was reviewed, with a focus on sex-specific requirements, in the following areas: nutrition for optimising muscle mass and function, nutrition during energy deficit, and nutrition for reproductive and bone health. RESULTS There are limited data on sex differences in protein requirements but extant data suggest that, despite less muscle mass, on average, in women, sex-specific protein feeding strategies are not required to optimise muscle mass in military-aged individuals. Similarly, despite sex differences in metabolic and endocrine responses to energy deficit, current data do not suggest a requirement for sex-specific feeding strategies during energy deficit. Energy deficit impairs health and performance, most notably bone and reproductive health and these impairments are greater for women. Vitamin D, iron and calcium are important nutrients to protect the bone health of female military personnel due to increased risk of stress fracture. CONCLUSIONS Women have an increased incidence of bone injuries, less muscle mass and are more susceptible to the negative effects of energy deficit, including compromised reproductive health. However, there are limited data on sex differences in response to various nutrition strategies designed to improve these elements of health and performance. Future studies should evaluate whether sex-specific feeding recommendations are required.
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Affiliation(s)
- Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom.
| | - Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, United States of America
| | - Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, United States of America
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom
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Barbeau P, Michaud A, Hamel C, Rice D, Skidmore B, Hutton B, Garritty C, da Silva DF, Semeniuk K, Adamo KB. Musculoskeletal Injuries Among Females in the Military: A Scoping Review. Mil Med 2021; 186:e903-e931. [PMID: 33367692 DOI: 10.1093/milmed/usaa555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/04/2020] [Accepted: 12/10/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Musculoskeletal injuries (MSKi) are a common challenge for those in military careers. Compared to their male peers, reports indicate that female military members and recruits are at greater risk of suffering MSKi during training and deployment. The objectives of this study were to identify the types and causes of MSKi among female military personnel and to explore the various risk factors associated with MSKi. MATERIALS AND METHODS A scoping review was conducted over a 4-month time frame of English language, peer-reviewed studies published from 1946 to 2019. Search strategies for major biomedical databases (e.g., MEDLINE; Embase Classic + Embase; and the following EBM Reviews-Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and the NHS Economic Evaluation Database) were developed by a senior medical information specialist and included 2,891 titles/abstracts. Study selection and data collection were designed according to the Population, Concept, and Context framework. Studies were included if the study population provided stratified data for females in a military context. RESULTS From a total of 2,287 citations captured from the literature searches, 168 peer-reviewed publications (144 unique studies) were eligible for inclusion. Studies were identified from across 10 countries and published between 1977 and 2019. Study designs were primarily prospective and retrospective cohorts. Most studies assessed both prevalence/incidence and risk factors for MSKi (62.50%), with few studies assessing cause (13.69%). For MSKi of female recruits compared to active female members, the prevalence was higher (19.7%-58.3% vs. 5.5%-56.6%), but the incidence (0.02%-57.7% vs. 13.5%-71.9%) was lower. The incidence of stress fractures was found to be much higher in female recruits than in active members (1.6%-23.9% vs. 2.7%). For anthropometric risk factors, increased body fat was a predictor of MSKi, but not stress fractures. For physiological risk factors for both female military groups, being less physically fit, later menarche, and having no/irregular menses were predictors of MSKi and stress fractures. For biomechanical risk factors, among female recruits, longer tibial length and femoral neck diameter increased the risk of stress fractures, and low foot arch increased risk of an ankle sprain. For female active military members, differences in shoulder rotation and bone strength were associated with risk of MSKi. For biological sex, being female compared to male was associated with an increased risk of MSKi, stress fractures, and general injuries. The consequences of experiencing MSKi for active military included limited duties, time off, and discharge. For recruits, these included missed training days, limited duty days, and release. CONCLUSIONS This scoping review provides insight into the current state of the evidence regarding the types and causes of MSKi, as well as the factors that influence MSKi among females in the military. Future research endeavors should focus on randomized controlled trials examining training paradigms to see if women are more susceptible. The data presented in the scoping review could potentially be used to develop training strategies to mitigate some of the identified barriers that negatively impact women from pursuing careers in the military.
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Affiliation(s)
- Pauline Barbeau
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Alan Michaud
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Candyce Hamel
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danielle Rice
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Chantelle Garritty
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danilo F da Silva
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kevin Semeniuk
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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8
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O'Leary TJ, Wardle SL, Greeves JP. Energy Deficiency in Soldiers: The Risk of the Athlete Triad and Relative Energy Deficiency in Sport Syndromes in the Military. Front Nutr 2020; 7:142. [PMID: 32984399 PMCID: PMC7477333 DOI: 10.3389/fnut.2020.00142] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022] Open
Abstract
Military personnel experience energy deficit (total energy expenditure higher than energy intake), particularly during combat training and field exercises where exercising energy expenditures are high and energy intake is reduced. Low energy availability (energy intake minus exercising energy expenditure expressed relative to fat free mass) impairs endocrine function and bone health, as recognized in female athletes as the Female Athlete Triad syndrome. More recently, the Relative Energy Deficiency in Sport (RED-S) syndrome encompasses broader health outcomes, physical and cognitive performance, non-athletes, and men. This review summarizes the evidence for the effect of low energy availability and energy deficiency in military training and operations on health and performance outcomes. Energy availability is difficult to measure in free-living individuals but doubly labeled water studies demonstrate high total energy expenditures during military training; studies that have concurrently measured energy intake, or measured body composition changes with DXA, suggest severe and/or prolonged energy deficits. Military training in energy deficit disturbs endocrine and metabolic function, menstrual function, bone health, immune function, gastrointestinal health, iron status, mood, and physical and cognitive performance. There are more data for men than women, and little evidence on the chronic effects of repeated exposures to energy deficit. Military training impairs indices of health and performance, indicative of the Triad and RED-S, but the multi-stressor environment makes it difficult to isolate the independent effects of energy deficiency. Studies supplementing with energy to attenuate the energy deficit suggest an independent effect of energy deficiency in the disturbances to metabolic, endocrine and immune function, and physical performance, but randomized controlled trials are lacking.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, UCL, London, United Kingdom
| | - Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, UCL, London, United Kingdom
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, UCL, London, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Schanda JE, Kocijan R, Resch H, Baierl A, Feichtinger X, Mittermayr R, Plachel F, Wakolbinger R, Wolff K, Fialka C, Gruther W, Muschitz C. Bone Stress Injuries Are Associated With Differences in Bone Microarchitecture in Male Professional Soldiers. J Orthop Res 2019; 37:2516-2523. [PMID: 31410876 DOI: 10.1002/jor.24442] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/07/2019] [Indexed: 02/04/2023]
Abstract
Bone stress injuries are commonly due to repetitive loading, as often described in competitive athletes or military recruits. The underlying pathophysiology of bone stress injuries is multifactorial. The present cross-sectional study investigated (i) cortical and trabecular bone microstructure as well as volumetric bone mineral density in subjects with bone stress injuries at the tibial diaphysis, measured at the distal tibia and the distal radius by means of high-resolution peripheral quantitative computed tomography (CT), (ii) areal bone mineral density using dual-energy X-ray absorptiometry as well as calcaneal dual X-ray absorptiometry and laser, and (iii) the influence on bone turnover markers of formation and resorption at the early phase after injury. A total of 26 Caucasian male professional soldiers with post-training bone stress injury at the tibial diaphysis were included (case group). A total of 50 male, Caucasian professional soldiers from the same military institution served as controls (control group). High-resolution peripheral quantitative CT revealed a higher total area at the radius within the case group. Cortical bone mineral density was reduced at the radius and tibia within the case group. The trabecular number and trabecular thickness were reduced at the tibia in the case group. The trabecular network was more inhomogeneous at the radius and tibia within the case group. Calcaneal dual X-ray absorptiometry and laser was significantly reduced in the case group. This study quantified differences in bone microstructure among otherwise healthy individuals. Differences in bone microarchitecture may impair the biomechanical properties by increasing the susceptibility to sustain bone stress injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2516-2523, 2019.
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Affiliation(s)
- Jakob E Schanda
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria
| | - Roland Kocijan
- Medical Department II-VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, Vienna, A-1060, Austria
| | - Heinrich Resch
- Medical Department II-VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, Vienna, A-1060, Austria.,Karl Landsteiner Institute for Gastroenterology, Rheumatology, and Osteology, Stumpergasse 13, Vienna, A-1060, Austria.,Medical Faculty, Bone Diseases Unit, Sigmund Freud University, Freudplatz 1, Vienna, A-1020, Austria
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Oskar-Morgenstern-Platz 1, Vienna, A-1090, Austria
| | - Xaver Feichtinger
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria
| | - Rainer Mittermayr
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria
| | - Fabian Plachel
- Charité-Universitätsmedizin Berlin, Campus Virchow, Center for Musculoskeletal Surgery, Augustenburger Platz 1, Berlin, D-13353, Germany
| | - Robert Wakolbinger
- Department of Physical Medicine and Rehabilitation, Danube Hospital-Social Medical Center East, Langobardenstrasse 122, Vienna, A-1220, Austria
| | - Klaus Wolff
- Department of Surgery, Austrian Armed Forces, Military Medical Cluster East, Bruenner Strasse 238, Vienna, A-1210, Austria
| | - Christian Fialka
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, Vienna, A-1120, Austria.,Medical Faculty, Traumatology Unit, Sigmund Freund University, Freudplatz 1, Vienna, A-1020, Austria
| | - Wolfgang Gruther
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
| | - Christian Muschitz
- Medical Department II-VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, Vienna, A-1060, Austria
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Lee EC, Fragala MS, Kavouras SA, Queen RM, Pryor JL, Casa DJ. Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes. J Strength Cond Res 2018; 31:2920-2937. [PMID: 28737585 PMCID: PMC5640004 DOI: 10.1519/jsc.0000000000002122] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Lee, EC, Fragala, MS, Kavouras, SA, Queen, RM, Pryor, JL, and Casa, DJ. Biomarkers in sports and exercise: tracking health, performance, and recovery in athletes. J Strength Cond Res 31(10): 2920–2937, 2017—Biomarker discovery and validation is a critical aim of the medical and scientific community. Research into exercise and diet-related biomarkers aims to improve health, performance, and recovery in military personnel, athletes, and lay persons. Exercise physiology research has identified individual biomarkers for assessing health, performance, and recovery during exercise training. However, there are few recommendations for biomarker panels for tracking changes in individuals participating in physical activity and exercise training programs. Our approach was to review the current literature and recommend a collection of validated biomarkers in key categories of health, performance, and recovery that could be used for this purpose. We determined that a comprehensive performance set of biomarkers should include key markers of (a) nutrition and metabolic health, (b) hydration status, (c) muscle status, (d) endurance performance, (e) injury status and risk, and (f) inflammation. Our review will help coaches, clinical sport professionals, researchers, and athletes better understand how to comprehensively monitor physiologic changes, as they design training cycles that elicit maximal improvements in performance while minimizing overtraining and injury risk.
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Affiliation(s)
- Elaine C Lee
- 1Department of Kinesiology, University of Connecticut, Storrs, Connecticut; 2Quest Diagnostics, Madison, New Jersey; 3Department of Health, Human Performance, & Recreation, University of Arkansas, Fayetteville, Arkansas; 4Department of Biomedical Engineering and Mechanics, Virginia Tech University, Blacksburg, Virginia; and 5Department of Kinesiology, California State University, Fresno, California
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Stress and Insufficiency Fractures. Clin Rev Bone Miner Metab 2017. [DOI: 10.1007/s12018-017-9239-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Drain JR, Groeller H, Burley SD, Nindl BC. Hormonal response patterns are differentially influenced by physical conditioning programs during basic military training. J Sci Med Sport 2017; 20 Suppl 4:S98-S103. [PMID: 28927970 DOI: 10.1016/j.jsams.2017.08.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Compare traditional military physical training and more contemporary physical training on catabolic and anabolic hormones and body composition in recruits undertaking basic military training (BMT). DESIGN A prospective cross-sectional study design. METHODS Two recruit intakes were assessed over the 12-week Australian Army BMT course. The control group (CON) comprised 40 recruits (26M/14F) and the experimental group (EXP) comprised 35 recruits (25M/10F). Hormone concentrations (IGF-I, testosterone, cortisol, SHBG) and body composition were assessed at weeks 1 and 12. The EXP group undertook a higher-load/intensity physical training regimen, while CON undertook the extant physical training program which focused on cardiovascular and muscular endurance. Total physical activity within physical training sessions was assessed during weeks 2, 6 and 9. RESULTS There was a significant group×time interaction (p<0.01) for IGF-I and cortisol, and main effects over time (p<0.01) for IGF-I, cortisol and SHBG. There were main effects for time (p<0.05) for lean and fat mass, and these changes were associated (p<0.05) with altered hormone concentrations. Physical activity levels were approximately 50% lower in EXP than CON during physical training sessions. CONCLUSIONS This is the first study to report a differential hormone response to contrasting physical conditioning regimen during BMT. The results indicate that the recruits who completed the EXP physical training regimen had an attenuated stress profile. This is an important observation, as any enhancement of recruit training outcomes are critical for Army noting that fundamentally, organisational capability is reliant upon the physical capability of its personnel.
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Affiliation(s)
- Jace R Drain
- Defence Science and Technology Group, Australia.
| | - Herbert Groeller
- Centre for Human and Applied Physiology, University of Wollongong, Australia
| | - Simon D Burley
- Centre for Human and Applied Physiology, University of Wollongong, Australia
| | - Bradley C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, USA
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Saunier J, Chapurlat R. Stress fracture in athletes. Joint Bone Spine 2017; 85:307-310. [PMID: 28512006 DOI: 10.1016/j.jbspin.2017.04.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/24/2017] [Indexed: 12/20/2022]
Abstract
Stress fractures are widely encountered in sport medicine and rheumatology. Stress fractures result from abnormal and repetitive loading on normal bone that lead to microdamage and then fracture. They occur after sudden increase in physical activity. They appear mostly at lower limbs. Women are at higher risk than men. Patients complain of mechanical pain. Clinical findings include focused pain and sometimes swelling. No biological test is useful for diagnosis. Plain radiographs are normal in early stage disease. MRI is the gold standard to confirm stress fracture. Treatments of stress fracture always involve rest and analgesics. Non-steroidal anti-inflammatory should be use cautiously because they may inhibit callus formation. Extracorporeal shockwave may be a new approach for SF not healing with rest. Surgical treatment is often needed in high risk stress fracture of delayed healing, non-union or complete fracture.
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Affiliation(s)
- Jordane Saunier
- Service de rhumatologie, CHU Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - Roland Chapurlat
- Service de rhumatologie, CHU Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
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Greeves JP. Physiological Implications, Performance Assessment and Risk Mitigation Strategies of Women in Combat-Centric Occupations. J Strength Cond Res 2015; 29 Suppl 11:S94-100. [DOI: 10.1519/jsc.0000000000001116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dao D, Sodhi S, Tabasinejad R, Peterson D, Ayeni OR, Bhandari M, Farrokhyar F. Serum 25-Hydroxyvitamin D Levels and Stress Fractures in Military Personnel: A Systematic Review and Meta-analysis. Am J Sports Med 2015; 43:2064-72. [PMID: 25371440 DOI: 10.1177/0363546514555971] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Low serum 25-hydroxyvitamin D (25(OH)D) levels have been associated with stress fractures in various physically active populations such as the military. PURPOSE To examine the association between serum 25(OH)D levels and stress fractures in the military. STUDY DESIGN Systematic review and meta-analysis. METHODS Relevant studies were identified through searching multiple databases and manually screening reference lists. Two reviewers independently selected the included studies by applying the eligibility criteria to the title, abstract, and/or full text of the articles yielded in the search. Two reviewers also independently conducted the methodological quality assessment and data extraction. A random-effects model was used to calculate the mean difference (MD) with 95% CI in serum 25(OH)D levels between stress fracture cases and controls. RESULTS Nine observational studies on lower extremity stress fractures were eligible, and 1 was excluded due to inadequate data. A total of 2634 military personnel (age, 18-30 years; 44% male) with 761 cases (16% male) and 1873 controls (61% male) from 8 studies were included in the analysis. Three of the 8 studies measured serum 25(OH)D levels at the time of stress fracture diagnosis, and the 5 remaining studies measured serum 25(OH)D levels at the time of entry into basic training. The mean serum 25(OH)D level was lower in stress fracture cases than in controls at the time of entry into basic training (MD, -2.63 ng/mL; 95% CI, -5.80 to 0.54; P = .10; I(2) = 65%) and at the time of stress fracture diagnosis (MD, -2.26 ng/mL; 95% CI, -3.89 to -0.63; P = .007; I(2) = 42%). CONCLUSION Despite the inherent limitations of the included studies, the study results suggest some association between low serum 25(OH)D levels and lower extremity stress fractures in military personnel. Given the rigorous training of military personnel, implementing strategies to ensure sufficient 25(OH)D levels may be beneficial for reducing the risk of stress fractures.
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Affiliation(s)
- Dyda Dao
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Sukhmani Sodhi
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Rasam Tabasinejad
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Devin Peterson
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Surgery, McMaster University, Hamilton, Ontario, Canada Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Surgery, McMaster University, Hamilton, Ontario, Canada Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
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Szivak TK, Mala J, Kraemer WJ. Physical Performance and Integration Strategies for Women in Combat Arms. Strength Cond J 2015. [DOI: 10.1519/ssc.0000000000000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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