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Ling DI, Hannafin JA, Prather H, Skolnik H, Chiaia TA, de Mille P, Lewis CL, Casey E. The Women's Soccer Health Study: From Head to Toe. Sports Med 2023; 53:2001-2010. [PMID: 37195359 PMCID: PMC10191093 DOI: 10.1007/s40279-023-01860-x] [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: 05/01/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Women are under-represented in the sports literature despite increasing rates of sports participation. Our objective was to investigate the risks and benefits of an elite women's soccer career in five health domains: general, musculoskeletal, reproductive endocrinology, post-concussion, and mental. METHODS An online survey was distributed to retired US college, semi-professional, professional, and national team soccer players using personal networks, email, and social media. Short validated questionnaires were used to evaluate the health domains, including the Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numerical Evaluation (SANE), Post-Concussion Symptom Scale (PCSS), and Patient Health Questionnaire (PHQ). RESULTS A total of 560 eligible players responded to the survey over a 1-year period. The highest competitive levels were 73% college, 16% semi-professional, 8% professional, and 4% national team. The mean number of years since retirement was 12 (SD = 9), and 17.0% retired for involuntary reasons. The mean SANE scores (0-100 scale as percentage of normal) were knee = 75% (SD = 23), hip = 83% (SD = 23), and shoulder = 87% (SD = 21). The majority (63%) reported that their current activity level included participation in impact sports. A substantial proportion of players reported menstrual irregularities during their careers: 40% had fewer periods with increasing exercise and 22% had no periods for ≥ 3 months. The players (n = 44) who felt that post-concussion symptoms were due to soccer reported more time-loss concussions (F[2] = 6.80, p = 0.002) and symptom severity (F[2] = 30.26, p < 0.0001). Players who recently retired (0-5 years) reported the highest anxiety/depression scores and lowest satisfaction rates compared with those who retired 19+ years ago. CONCLUSION Health concerns include musculoskeletal injuries, post-concussion symptoms, and lower mental health in the early years following retirement. This comprehensive survey provides initial results that will lay the foundation for further analyses and prioritize research studies that can help all female athletes.
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Affiliation(s)
- Daphne I Ling
- Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Hospital for Special Surgery, New York, USA.
- Weill Cornell Medical College, New York, USA.
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Matsumoto C, Ishizaka M, Kubo A, Itokazu M. Female athlete triad cross-sectional study of soccer players by level of competition. J Phys Ther Sci 2023; 35:170-174. [PMID: 36866004 PMCID: PMC9974323 DOI: 10.1589/jpts.35.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/01/2022] [Indexed: 03/04/2023] Open
Abstract
[Purpose] To determine the actual status of the Female Athlete Triad (low energy availability, menstrual dysfunction, and bone mineral density loss) in soccer players. [Participants and Methods] The survey was conducted between February 1 and March 1, 2022. It included 115 females between the ages of 12 and 28 registered with the Japan Football Association, from teams at different levels. [Results] Players in the top league did not differ in height and weight but were older and had a better understanding of caloric intake. There were no differences in amenorrhea or history of bone fractures based on league. [Conclusion] Of the female soccer players in the four different levels of competition, only the players in the top league had a better understanding of available energy and took preventive measures against the Female Athlete Triad.
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Affiliation(s)
- Chiaki Matsumoto
- Department of Physical Therapy, School of Health Sciences,
International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara-shi, Tochigi
324-8501, Japan,Corresponding author. Chiaki Matsumoto (E-mail: )
| | - Masahiro Ishizaka
- Department of Physical Therapy, School of Health Sciences,
International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara-shi, Tochigi
324-8501, Japan
| | - Akira Kubo
- Department of Physical Therapy, School of Health Sciences,
International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara-shi, Tochigi
324-8501, Japan
| | - Masafumi Itokazu
- Department of Physical Therapy, School of Health Sciences,
International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara-shi, Tochigi
324-8501, Japan
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von Rosen P, Ekenros L, Solli GS, Sandbakk Ø, Holmberg HC, Hirschberg AL, Fridén C. Offered Support and Knowledge about the Menstrual Cycle in the Athletic Community: A Cross-Sectional Study of 1086 Female Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11932. [PMID: 36231231 PMCID: PMC9564720 DOI: 10.3390/ijerph191911932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Many female athletes perceive that symptoms related to the menstrual cycle such as dysmenorrhea, premenstrual symptoms, amenorrhea or side-effects of hormonal contraceptives negatively impact their training, performance, and general well-being. Knowledge and communication about female athletes' health is therefore important in the sport community. The aims of this study were to explore the level of knowledge and communication about menstrual cycle issues and use of hormonal contraceptives in the athletic community and to describe the kinds of medical support offered to female athletes. A total of 1086 Swedish and Norwegian athletes from 57 different sports responded to a web-based questionnaire. Of these, 58% (n = 627) practiced team sports and 42% (n = 459) individual sports. Twenty-six percent (n = 278) of the athletes perceived their knowledge about female athlete health to be poor/very poor and the knowledge was most often acquired from medical staff. Fifty-three percent (n = 572) of the athletes perceived the knowledge acquired of their coaches as poor/very poor, even though a significantly (p < 0.001) higher proportion of athletes with a female coach (30%, n = 31) rated their coach's knowledge as very good/good, compared to athletes with a male coach (5%, n = 31). Only 11% (n = 116) of the athletes discussed female health issues with their coach. The majority (81%, n = 842) of the athletes partly to strongly agreed that female athlete health is considered a taboo topic in the athletic community. Forty-seven percent (n = 510) of the athletes had access to a physiotherapist, while only three percent (n = 29) had access to a gynecologist. Low perceived knowledge, lack of communication and support demonstrate the need for a multi-professional medical team and enhanced educational efforts focused on female athlete health in the athletic community.
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Affiliation(s)
- Philip von Rosen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden
| | - Linda Ekenros
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden
| | - Guro Strøm Solli
- School of Sport Sciences, UiT—The Arctic University of Norway, 9019 Tromsoe, Norway
- Department of Sports Science and Physical Education, Nord University, 8026 Bodø, Norway
| | - Øyvind Sandbakk
- School of Sport Sciences, UiT—The Arctic University of Norway, 9019 Tromsoe, Norway
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, 7034 Trondheim, Norway
| | - Hans-Christer Holmberg
- Department of Health Sciences, Lulea University of Technology, 971 87 Lulea, Sweden or
- Department of Physiology and Pharmacology, Biomedicum C5, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 76 Stockholm, Sweden or
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Cecilia Fridén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 76 Stockholm, Sweden or
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Stickler L, Garvin N, Kuhlman K, Saturley H, Hoogenboom BJ. Runner's health choices questionnaire: female collegiate cross-country runners' perspectives on health and eating. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1848-1857. [PMID: 33151842 DOI: 10.1080/07448481.2020.1837842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/21/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess female collegiate cross-country runners' perspectives regarding sport-related health and the factors impacting eating behaviors. PARTICIPANTS/METHODS The Runner's Health Choices Questionnaire, a previously validated survey, was electronically distributed to female collegiate cross-country runners. Quantitative descriptive analysis was performed on all questions. RESULTS A total of 353 female collegiate cross-country runners completed the survey. The most common intrinsic factors that impacted overall diet type were makes you feel healthy, enjoyment of food, and athletic performance enhancement. Extrinsic factors such as practice/race that day, creating a balanced diet, and choices in the cafeteria were the top factors influencing daily meal decisions. Seventy-seven percent of athletes reported that they would be likely to apply information from a healthcare professional if they had access. CONCLUSION Female cross-country runners appeared willing to apply nutritional information; therefore, it is important that generalized nutrition education with an emphasis on intrinsic and extrinsic factors for food choices be considered for female collegiate cross-country runners.
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Affiliation(s)
- Laurie Stickler
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Nickay Garvin
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Kristen Kuhlman
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Heather Saturley
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Barbara J Hoogenboom
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, Michigan, USA
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Sweeney E, Howell DR, Seehusen CN, Tilley D, Casey E. Health outcomes among former female collegiate gymnasts: the influence of sport specialization, concussion, and disordered eating. PHYSICIAN SPORTSMED 2021; 49:438-444. [PMID: 33186080 DOI: 10.1080/00913847.2020.1850150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective: Gymnastics is a popular sport with high injury rates, especially at the collegiate level. There is limited evidence, however, regarding the risks of early specialization in this sport, the rate of concussions in gymnasts, and the long-term effects of disordered eating in gymnasts. We sought to describe health-related outcomes of former collegiate gymnasts and the association with early sport specialization, concussion history, and disordered eating.Methods: We distributed an online survey through social media outlets. A total of 473 former female collegiate gymnasts completed the survey and were grouped according to early (<14 years) specialization, presence or absence of concussion history, and history of disordered eating. We determined the number of participants who had time-loss injuries, injuries requiring surgery, and injuries resulting in retirement. We also evaluated menstrual history, reasons for sport retirement, functional outcome measures, and mental health.Results: The median age of gymnastics specialization was 8 years [interquartile range = 6-11 years]. The proportion of injuries sustained during college did not significantly differ by specialization age. A significantly greater proportion of early specializers required surgery for college sports-related injuries (60% vs. 44%; p = 0.02). Forty-two percent of the respondents reported concussion history, and a greater proportion of those with concussion history reported seeking mental health treatment during college (32% vs. 23%; p = 0.03), and anxiety disorder diagnosis (16% vs. 9%; p = 0.01). Disordered eating history was reported by 34% of the respondents, and this group had a higher proportion of time-loss injury (78% vs 65%; p = 0.004), and osteoporosis (4% vs 0%; p = 0.003) during college, and worse current pain (11.5 vs 10.2; p = 0.007) and physical function (12.2 vs 11.0; p = 0.01) than those without disordered eating.Conclusion: Athletes and clinicians should be aware of the long-term effects of early specialization, concussions, and disordered eating in gymnastics as these issues are common in female collegiate gymnasts.
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Affiliation(s)
- Emily Sweeney
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.,Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.,Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA
| | | | - David Tilley
- Champion Physical Therapy and Performance, Waltham, MA, USA
| | - Ellen Casey
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
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6
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Potential Low Energy Availability (LEA) Risk Amongst Amateur and Recreational Athletes in Singapore. PHYSICAL ACTIVITY AND HEALTH 2021. [DOI: 10.5334/paah.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Leggett-James MP, Vanaman ME, Lindner D, Askew RL. The Development and Psychometric Evaluation of the Exercise Overvaluation Scale. JOURNAL OF SPORT & EXERCISE PSYCHOLOGY 2021; 43:223-233. [PMID: 33883297 DOI: 10.1123/jsep.2019-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/15/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
While regular exercise is associated with a number of physical and mental health benefits, basing one's self-esteem largely on exercise is likely associated with negative outcomes. In the present studies, the authors developed a novel measure of this construct, something they term "exercise overvaluation." In Study 1, 820 participants completed an online survey measuring self-esteem, exercise attitudes and behaviors, and eating disorder symptoms. Exploratory and confirmatory factor analysis were employed to develop the 14-item Exercise Overvaluation Scale. The results provided evidence of discriminant and convergent validity and internal consistency reliability of scale scores. In Study 2, the Exercise Overvaluation Scale was administered to 134 university athletes, including those who participated in intramural sports, club sports, and collegiate athletics. The results from Study 2 supported the criterion validity and test-retest reliability of scale scores. This scale offers researchers a new tool to help understand the relationships among exercise, self-esteem, and physical and mental health outcomes.
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8
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Ali A, Mehta S, Starck C, Wong M, O'Brien WJ, Haswell C, McNabb W, Rutherfurd-Markwick K, Ahmed Nasef N. Effect of SunGold Kiwifruit and Vitamin C Consumption on Ameliorating Exercise-Induced Stress Response in Women. Mol Nutr Food Res 2021; 65:e2001219. [PMID: 33793050 DOI: 10.1002/mnfr.202001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/14/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Markers of oxidative and psychological stress are elevated during high-intensity exercise. Additionally, when energy intake does not match expenditure, women who actively participate in sports and exercise are at risk of developing menstrual dysfunction, infertility, and osteoporosis. Vitamin C is known to reduce exercise-induced stress. Here, this study investigates the efficacy of consuming vitamin C from SunGold kiwifruit compared to in isolation, in ameliorating exercise-induced stress in recreationally active women. METHODS AND RESULTS Ten eumenorrheic women are recruited in this crossover study and attended three exercise and one rest trial. In the exercise trials, participants consumed 300 mg vitamin C from kiwifruit or drink, or have a placebo drink, followed by 30-min exercise on a cycle ergometer at 60% power. During rest visit, participants sat quietly and consumed a placebo drink. Salivary uric acid (oxidative stress) and cortisol (psychological stress) are measured before and immediately after exercise for 2 h. Both vitamin C and kiwifruit reduced exercise-induced uric acid, immediately after exercise. Vitamin C drink continued to decrease uric acid for a further 30 min and slightly attenuated exercise-induced cortisol. CONCLUSIONS Consuming liquid vitamin C prior to high-intensity cycling appears more effective than eating kiwifruit, in ameliorating exercise-induced stress in recreationally active women of reproductive age.
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Affiliation(s)
- Ajmol Ali
- School of Sport, Exercise and Nutrition, Massey University, Auckland, 0745, New Zealand
| | - Sunali Mehta
- Pathology Department, University of Otago, Dunedin, 9054, New Zealand.,Maurice Wilkins Centre for Biodiscovery, University of Otago, Dunedin, 9054, New Zealand
| | - Carlene Starck
- Riddet Institute, Massey University, Private Bag 11222, Palmerston North, 4442, New Zealand
| | - Marie Wong
- School of Food and Advanced Technology, Massey University, Auckland, 0745, New Zealand
| | - Wendy J O'Brien
- School of Sport, Exercise and Nutrition, Massey University, Auckland, 0745, New Zealand
| | - Cameron Haswell
- School of Health Sciences, Massey University, Auckland, 0745, New Zealand
| | - Warren McNabb
- Riddet Institute, Massey University, Private Bag 11222, Palmerston North, 4442, New Zealand
| | | | - Noha Ahmed Nasef
- Riddet Institute, Massey University, Private Bag 11222, Palmerston North, 4442, New Zealand
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Foley Davelaar CM, Ostrom M, Schulz J, Trane K, Wolkin A, Granger J. Validation of an Age-Appropriate Screening Tool for Female Athlete Triad and Relative Energy Deficiency in Sport in Young Athletes. Cureus 2020; 12:e8579. [PMID: 32670715 PMCID: PMC7358951 DOI: 10.7759/cureus.8579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to determine the concurrent validity of a newly created relative energy deficiency in sport (RED-S) specific screening tool (RST) by comparing scores with the validated pre-participation gynecological examination (PPGE). We hypothesized that the investigators would observe no significant difference between the means of the RST and the PPGE survey. Methods This was a crossover study of 39 female subjects who completed both the RST and the PPGE. The survey order was randomized. Results The RST was validated compared with the PPGE (Pearson’s r = 0.697, p < 0.001). Conclusion The administration of an RST to middle- and high-school female athletes was validated compared with the PPGE. Formatting limitations of the screening tool were highlighted, leading to changes that improved the accuracy of the screening tool prior to application in a clinical setting. The RST is an age-appropriate screening tool that can be used by coaches, athletic trainers, physical therapists, and other healthcare practitioners to detect RED-S risk and allow for earlier intervention.
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Affiliation(s)
| | - Megan Ostrom
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA
| | - Justine Schulz
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA
| | - Katelyn Trane
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA
| | - Amy Wolkin
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA
| | - Julie Granger
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA
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Abbott A, Bird M, Brown SM, Wild E, Stewart G, Mulcahey MK. Part II: presentation, diagnosis, classification, treatment, and prevention of stress fractures in female athletes. PHYSICIAN SPORTSMED 2020; 48:25-32. [PMID: 31295036 DOI: 10.1080/00913847.2019.1636546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objectives: Stress fractures (SFx) occur as the result of repetitive loads over short periods of time, which leads to micro-damage of the bone through cortical resorption, ultimately leading to fracture. They are a common injury in female athletes and often cause significant morbidity. The goal of this study is to review the presentation, diagnosis, classification, treatment, and prevention of SFx in female athletes.Results: A thorough history, physical exam, and appropriate imaging can facilitate early diagnosis of stress fracture (SFx) and faster resolution of symptoms with more conservative management. The female athlete triad is an especially important factor that contributes to the increased risk of SFx in females. The continuum of stress injuries ranges from mild microfailure to complete fracture, which has resulted in the development of newer grading schemas through MRI and radiographic findings. Stress fractures are also classified as low- or high-risk according to anatomic location, as blood supply and applied forces at different locations affect the likelihood of fracture propagation, displacement, delayed union, or non-union.Conclusions: The ability to screen for at-risk athletes is paramount in preventing SFx. Recognition and prompt treatment of the female athlete triad requires a multidisciplinary approach in order to restore energy balance, correct menstrual irregularities, and improve bone health. This review provides a basis for understanding how to identify and treat stress fractures, which may allow treating physicians to diagnose this condition earlier and minimize any associated morbidity.
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Affiliation(s)
- Alexandra Abbott
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Mackenzie Bird
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Symone M Brown
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emily Wild
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Greg Stewart
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Abbott A, Bird ML, Wild E, Brown SM, Stewart G, Mulcahey MK. Part I: epidemiology and risk factors for stress fractures in female athletes. PHYSICIAN SPORTSMED 2020; 48:17-24. [PMID: 31213104 DOI: 10.1080/00913847.2019.1632158] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Stress fractures (SFx) are a common athletic injury, occurring in up to 40% of athletes at some point in their career. These injuries can cause pain, permanent disability, financial burden, and loss of playing time. This review presents updated epidemiology and comprehensive analysis of risk factors for stress fractures, especially as it pertains to female athletes.Results: Stress fractures (SFx) account for up to 10% of all orthopedic injuries and up to 20% of injuries seen in sports medicine clinics, with an incidence among female athletes as high as 13%. Lower extremity SFx represent 80-95% of SFx, and the increased popularity of endurance running has contributed to the tibia (49% prevalence) replacing the metatarsals (9%) as the most common location for lower extremity SFx. Studies have demonstrated that 50% of peak bone mass is acquired during adolescence, a 'peak time' for eating disorder and female athlete triad development; furthermore, catch-up growth cannot be expected in athletes with diminished bone growth in this critical period. The female athlete triad (low energy availability with or without disordered eating, menstrual dysfunction, and low bone mineral density) are well-known risk factors for SFx; the risk of SFx for female athletes presenting with a single aspect of the triad is 15-20%, and this risk increases to 30-50% for female athletes presenting with multiple aspects of the triad.Conclusion: This review provides a basis for how to identify populations at greatest risk for SFx. Prompt recognition of the intrinsic and extrinsic risk factors for SFx in female athletes is imperative to early diagnosis and to develop targeted strategies to prevent SFx occurrence or recurrence.
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Affiliation(s)
- Alexandra Abbott
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Emily Wild
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Symone M Brown
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Greg Stewart
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Krick RL, Brown AF, Brown KN. Increased Female Athlete Triad Knowledge Following a Brief Video Educational Intervention. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:1126-1129. [PMID: 31278017 DOI: 10.1016/j.jneb.2019.05.600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/26/2019] [Accepted: 05/29/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Rachel L Krick
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID; Terry Reilly Health Services, Nampa, ID
| | - Ann F Brown
- Department of Movement Sciences, University of Idaho, Moscow, ID
| | - Katie N Brown
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID; Department of Nutrition, Dietetics & Food Science, Utah State University, Logan, UT.
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13
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Tosi M, Maslyanskaya S, Dodson NA, Coupey SM. The Female Athlete Triad: A Comparison of Knowledge and Risk in Adolescent and Young Adult Figure Skaters, Dancers, and Runners. J Pediatr Adolesc Gynecol 2019; 32:165-169. [PMID: 30395981 DOI: 10.1016/j.jpag.2018.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/24/2018] [Accepted: 10/27/2018] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE The female athlete triad is often found in sports that value leanness and aesthetics and can lead to adverse health effects. We aimed to compare knowledge and risk of the triad among adolescent figure skaters, dancers, and runners. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURES We advertised our survey on social media platforms: sports-specific forums; Facebook; and Instagram. We received 928 responses. We included female figure skaters, dancers, and runners aged 25 years or younger (N = 712). We asked participants to name the triad components and dichotomized knowledge scores as high or low. We developed a 6-question triad risk scale and defined "at risk" if participants endorsed 3 or more questions. RESULTS Of 712 participants: 60% were figure skaters; 28% dancers; 12% runners; 78% were adolescents (≤17 years of age); 22% young adults (18-25 years); 12% had heard of the triad. A higher proportion of runners than figure skaters and dancers had high knowledge of the triad (16% vs 6% vs 5%, P < .01). Overall 60% of athletes were "at risk" of the triad, 25% skipped a period for 3 or more months, and 34% had a history of stress fractures or shin splints. Young adults vs adolescents and dancers vs figure skaters and runners had nearly twice the odds of triad risk. CONCLUSION Most athletes were at risk of the triad but few knew about it. Dancers were at higher risk compared with figure skaters and runners. Efforts should be made to raise awareness of the triad among athletes, parents, and coaches, with special attention paid to the dance community.
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Affiliation(s)
- Marina Tosi
- Original Science Research Program, Mamaroneck High School, Mamaroneck, New York
| | - Sofya Maslyanskaya
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Nancy A Dodson
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Susan M Coupey
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York.
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14
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Petkus DL, Murray-Kolb LE, De Souza MJ. The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review. Sports Med 2018; 47:1721-1737. [PMID: 28290159 DOI: 10.1007/s40279-017-0706-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite the severity and prevalence of iron deficiency in exercising women, few published reports have explored how iron deficiency interacts with another prevalent and severe condition in exercising women: the 'female athlete triad.' This review aims to describe how iron deficiency may interact with each component of the female athlete triad, that is, energy status, reproductive function, and bone health. The effects of iron deficiency on energy status are discussed in regards to thyroid function, metabolic fuel availability, eating behaviors, and energy expenditure. The interactions between iron deficiency and reproductive function are explored by discussing the potentially impaired fertility and hyperprolactinemia due to iron deficiency and the alterations in iron metabolism due to menstrual blood loss and estrogen exposure. The interaction of iron deficiency with bone health may occur via dysregulation of the growth hormone/insulin-like growth factor-1 axis, hypoxia, and hypothyroidism. Based on these discussions, several future directions for research are presented.
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Affiliation(s)
- Dylan L Petkus
- Department of Kinesiology, The Pennsylvania State University, 104 Noll Laboratory, University Park, PA, 16802, USA
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Mary Jane De Souza
- Department of Kinesiology, The Pennsylvania State University, 104 Noll Laboratory, University Park, PA, 16802, USA.
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15
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Bowden JA, Bowden AE, Wang H, Hager RL, LeCheminant JD, Mitchell UH. In vivo correlates between daily physical activity and intervertebral disc health. J Orthop Res 2018; 36:1313-1323. [PMID: 28976592 DOI: 10.1002/jor.23765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/27/2017] [Indexed: 02/04/2023]
Abstract
Physical activity impacts health and disease in multiple body tissues including the intervertebral discs. Fluid flow within the disc is an indicator of disc health that can be observed using diffusion weighted magnetic resonance imaging. We monitored activity levels of 26 participants, age 35-55 yrs, using Actigraph accelerometers for 4 days to evaluate vigorous-intensity activity, moderate to vigorous intensity activity, and sedentary time. Participants underwent structural and diffusion weighted magnetic resonance imaging to evaluate intervertebral disc health and fluid flow. They also underwent bone density scans, carotid artery ultrasounds, a treadmill test, and a physical exam for pain, range of motion, and instability. These measures were used to correlate MRI indicators of intervertebral disc health with participant activity levels. Participants with any vigorous-intensity physical activity compared with no vigorous-intensity activity had significantly greater L5/S1 apparent diffusion coefficient values (p = 0.002), corresponding to higher freedom of diffusive movement for cellular nutrients and metabolic waste. Sagittal T2 values in the L5/S1 were also higher (p = 0.004), corresponding to a higher water content in the discs. Higher apparent diffusion coefficients were also found in participants with more than 30 min compared with less than 30 min of daily moderate to vigorous physical activity (p = 0.03), and in participants with less than 67% awake time as sedentary time compared with more than 67% sedentary time (p = 0.03). Increased dynamic loading through physical activity and decreased static loading from sedentary time benefit intervertebral disc health. Physical activity, particularly vigorous activity, is beneficial in helping maintain intervertebral disc health. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1313-1323, 2018.
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Affiliation(s)
- Jennifer A Bowden
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, 84602
| | - Anton E Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, 84602
| | - Haonan Wang
- Department of Electrical and Computer Engineering, Brigham Young University, Provo, Utah, 84602
| | - Ron L Hager
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, 84602
| | - James D LeCheminant
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, 84602
| | - Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, 84602
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16
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The Role of Division III Sports Participation in the Relationship Between Perfectionism and Disordered Eating Symptomology. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2018. [DOI: 10.1123/jcsp.2017-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Preliminary Evidence of an Association Between ADHD Medications and Diminished Bone Health in Children and Adolescents. J Pediatr Orthop 2017; 37:348-354. [PMID: 26398435 DOI: 10.1097/bpo.0000000000000651] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The US Centers for Disease Control and Prevention estimate that 3.5 million children use psychotropic drugs for attention-deficit hyperactivity disorder (ADHD). With an increase in use of these types of drugs, thorough understanding of their potential side effects on the growing skeleton is needed. The purpose of this study was to determine whether there is an association between use of ADHD medication and diminished bone health. METHODS Three waves of the National Health and Nutrition Examination Survey public-use data set, collected from 2005 through 2010, were compiled for this study (N=5315). Bone health was measured using dual-energy x-ray absorptiometry scans, which were performed for participants aged 8 to 17 years to determine bone mineral density (BMD) for 3 regions: (1) total femur; (2) femoral neck; and (3) lumbar. Use of ADHD medications was determined by self-reported responses to questions regarding prescription drug use, which were answered by either the respondent or the respondent's parent or guardian. Multiple statistical techniques were used to produce estimates of association between ADHD medication use and z score age and sex standardized BMD measures, including survey adjusted univariate, survey adjusted multiple linear regression, and generalized estimating equations with a propensity-matched subsample (N=1967). Multivariate models adjusted for covariates including time period, age, sex, race/ethnicity, family income to poverty ratio, and total number of prescription medications. RESULTS Conservative estimates of the difference in standardized BMD measures between the ADHD medication group and the nonmedicated group range from -0.4855 (±0.27; P<0.001) for total femoral, -0.4671 (±0.27; P<0.001) for femoral neck, and -0.3947 (±0.29; P<0.01) for lumbar. Significantly more children on ADHD medications versus match subjects on no medication had BMDs with in osteopenic range (38.3% vs. 21.6%, P<0.01). DISCUSSION The findings suggest that there are real and nontrivial differences in BMD for children and adolescents taking ADHD medications, as compared with similar children not taking any prescription medications. Prescribing physicians and parents should be aware of potential bone health risks associated with these medications. LEVEL OF EVIDENCE Level III-case-control study.
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18
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von Rosen P, Heijne A, Frohm A, Fridén C. Menstrual irregularity and use of oral contraceptives in female adolescent athletes in Swedish National Sports High Schools. Int J Adolesc Med Health 2017; 32:/j/ijamh.ahead-of-print/ijamh-2017-0113/ijamh-2017-0113.xml. [PMID: 29168967 DOI: 10.1515/ijamh-2017-0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/08/2017] [Indexed: 11/15/2022]
Abstract
Objective Female adolescent athletes seem to use oral contraceptives (OCs) in the same proportion as the general population. In athletes not using OCs, menstrual irregularity (MI) is reported to be common but there are few studies of MI in adolescent athletes. The aim of the study was to survey menarche, menstrual irregularity and use of OCs in adolescent athletes in the National Sports High Schools in Sweden. A further aim was to study the associations between current sport injury and menstrual irregularity as well as use of OCs. Subjects Two hundred and ninety-eight female adolescent athletes at Swedish National Sports High Schools. Methods A web-based questionnaire containing questions related to menstrual status, contraception and current injury. Results One third (32.6%) of the athletes used OCs and of the remaining athletes 31.8% had MI. The group of athletes with MI had a significantly (p = 0.038; Cohen's d, 0.32) lower BMI and consisted of a significantly (p = 0.043) higher proportion of endurance athletes. OC users were less likely to participate in endurance sports compared to non-OC users (p = 0.024). Current injury was equally distributed in the OC and the non-OC group but athletes with MI had fewer sports injuries compared to eumenorrheic women. Conclusion OCs are frequently used among athletes at Swedish National Sports High Schools. OC users were less likely to participate in endurance sports compared to non-OC users. MI was common and athletes with MI had lower BMI compared to eumenorrheic athletes. Sports injuries were not associated with use of OC and eumenorrheic athletes had a higher proportion of current injury.
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Affiliation(s)
- Philip von Rosen
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Annette Heijne
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Anna Frohm
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Swedish Sports Confederation Center, Bosön Sports Clinic, Lidingö, Sweden
| | - Cecilia Fridén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, 23100, Karolinska Institutet, 141 86 Huddinge, Sweden, Phone: +46707415122
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19
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Female Athlete Triad: Future Directions for Energy Availability and Eating Disorder Research and Practice. Clin Sports Med 2017; 36:671-686. [PMID: 28886821 DOI: 10.1016/j.csm.2017.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Despite more than 3 decades of research on the Female Athlete Triad, research gaps remain. Although low energy availability (EA) is the key etiologic factor in the Triad and the pathways to low EA are varied, its effects can be modified by several factors. Accurate screening, diagnosis, and treatment of disordered eating are a challenge; however, recent techniques combined with novel educational and behavior interventions prove promising. Recently published practice-based guidelines have helped to translate Triad science and should improve as they are refined. This article identifies the current state of research and distinguishes areas that require further investigation.
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20
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Brown KA, Dewoolkar AV, Baker N, Dodich C. The female athlete triad: special considerations for adolescent female athletes. Transl Pediatr 2017; 6:144-149. [PMID: 28795004 PMCID: PMC5532188 DOI: 10.21037/tp.2017.04.04] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The number of adolescent girls participating in sports has dramatically increased throughout the last few decades. In the early 1990's, an association between amenorrhea, osteoporosis, and disordered eating was recognized and eventually labeled the 'Female Athlete Triad'. In 1997, the Task Force on Women's Issues of American College of Sports Medicine (ACSM) published a position statement on this triad of conditions that were becoming increasingly more prevalent amongst female athletes. Initially, the 'Female Athlete Triad' was characterized by disordered eating, amenorrhea, and osteoporosis. However, as the number of adolescent female athletes has continued to grow, there has been further research and investigation into this field and the triad has evolved in definition. It is essential for all health care practitioners and other professionals who care for adolescent athletes to be attentive to the clinical signs, detection, evaluation, and management of the female athlete triad, as the sequelae can have a significant impact on the health and well-being of a young person both in the short and long-term.
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Affiliation(s)
- Kelly A Brown
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Aditya V Dewoolkar
- Louisiana State University HSC, Children's Hospital of New Orleans, New Orleans, Louisiana, USA
| | - Nicole Baker
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Colleen Dodich
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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21
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Duignan M, O'Connor N. Female athlete triad: At breaking point. Int Emerg Nurs 2017; 34:51-54. [PMID: 28442226 DOI: 10.1016/j.ienj.2017.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/26/2017] [Indexed: 11/20/2022]
Affiliation(s)
| | - Niall O'Connor
- Our Lady's Hospital, Navan, Ireland; Our Lady of Lourdes Hospital, Drogheda, Ireland
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22
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Tinker A, Haines E, Molloy L, Pennells L, Russell E, Monks I. What future for older women ex-athletes? Med Chir Trans 2017; 110:129-130. [DOI: 10.1177/0141076817692157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anthea Tinker
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
| | - Elodie Haines
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
| | - Laura Molloy
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
| | - Laura Pennells
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
| | - Evelina Russell
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
| | - Imogen Monks
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
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23
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Maïmoun L, Paris F, Coste O, Sultan C. [Intensive training and menstrual disorders in young female: Impact on bone mass]. ACTA ACUST UNITED AC 2016; 44:659-663. [PMID: 27751748 DOI: 10.1016/j.gyobfe.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
Participation in recreational physical activity is widely acknowledged to provide significant health benefits. Conversely, intense training imposes several constraints, such as intermittent or chronic metabolic and psychogenic training stressors and maintenance of very low body fat to maximize performance. Adolescent and adult athletic women are therefore at risk of overtraining and/or poor dietary intake, which may have several consequences for endocrine function particularly on hypothalamic-pituitary-gonadal axis. Female athletes, particularly those participating in sports needing leanness or low body weight, present a high prevalence of menstrual disorders with clinical manifestations ranging from delayed menarche, oligomenorrhea to primary and secondary amenorrhea. A high degree of variability according to the type of sport and the intensity of the practice is however observed. Exercise-related reproductive dysfunction may have some consequences for growth velocity and peak bone mass acquisition during adolescence and bone pathologies in adults. Recent findings highlight the endocrine role of adipose tissue and energy balance in the regulation of homeostasis and reproductive function. A better understanding of the mechanisms whereby intense training affects the endocrine systems may orient research to develop innovative strategies probably based on individualized nutritional approach to improve the medical care of these female athletes and protect their reproductive function.
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Affiliation(s)
- L Maïmoun
- Service de médecine nucléaire, hôpital Lapeyronie, université de Montpellier 1 (UM1), CHRU de Montpellier, 34295 Montpellier, France; PhyMedExp, University of Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France.
| | - F Paris
- Unité d'endocrinologie et gynécologie pédiatrique, département de pédiatrie, hôpital A.-de-Villeneuve, UMI, CHRU de Montpellier, 34295 Montpellier, France
| | - O Coste
- Direction régionale de la jeunesse, des sports et de la cohésion sociale Languedoc Roussillon/Midi-Pyrénées, France
| | - C Sultan
- Unité d'endocrinologie et gynécologie pédiatrique, département de pédiatrie, hôpital A.-de-Villeneuve, UMI, CHRU de Montpellier, 34295 Montpellier, France
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24
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Otağ A, Hazar M, Otağ İ, Beyleroğlu M. Effect of increasing maximal aerobic exercise on serum gonadal hormones and alpha-fetoprotein in the luteal phase of professional female soccer players. J Phys Ther Sci 2016; 28:807-10. [PMID: 27134362 PMCID: PMC4842443 DOI: 10.1589/jpts.28.807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/01/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The performance of female athletes during their menstrual period has attracted the attention of researchers for many years. It is known that the menstrual period changes with exercise. Alpha-fetoprotein (AFP) is an oncofetal protein. In this study, the effect of maximal aerobic exercise in the luteal phase on some hormones and AFP in female athletes was researched. [Subjects and Methods] Twelve volunteers and healthy female footballers with normal menstrual cycles volunteered for this study as subjects. All the participants performed a shuttle run test. Blood samples were taken before, after, and one hour after exercise. Serum AFP, estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) values were measured using an auto analyzer and original kits. Heart rate measurements were performed before and after the exercise. [Results] AFP activity had significantly decreased after 1 h of recovery from the exercise in the female soccer players, and estrogen and LH activity had significantly increased immediately after the exercise. Progesterone activity had significantly decreased immediately after the exercise. FSH values had significantly increased immediately after the exercise. [Conclusion] The results of the present study show there were significant decreases in the values of AFP, which is a cancer parameter, 1 hour after the exercise. This result may be valuable in future physiotherapy studies on the relationship between exercise and cancer.
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Affiliation(s)
- Aynur Otağ
- Department of Physiotherapy, Faculty of Health Sciences, Cumhuriyet University, Turkey
| | - Muhsin Hazar
- School of Physical Education and Sports, Gazi University, Turkey
| | - İlhan Otağ
- Vocational School of Health Services, Cumhuriyet University, Turkey
| | - Malik Beyleroğlu
- School of Physical Education and Sports, Sakarya University, Turkey
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25
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Curry EJ, Logan C, Ackerman K, McInnis KC, Matzkin EG. Female Athlete Triad Awareness Among Multispecialty Physicians. SPORTS MEDICINE-OPEN 2015; 1:38. [PMID: 26587370 PMCID: PMC4642583 DOI: 10.1186/s40798-015-0037-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 09/11/2015] [Indexed: 12/31/2022]
Abstract
Background The female athlete triad (Triad) is a serious condition with lifelong consequences seen in physically active females. Prior studies assessing Triad knowledge among coaches/athletic trainers reported surprisingly low awareness results. Our aims were to (1) determine the percentage of physicians across multiple specialties who had heard of the phrase “female athlete triad” and (2) determine the percentage who can properly diagnose or have a high comfort level appropriately referring these patients. Methods Via electronic survey, we recruited medical staff, residents, and fellows at three large academic institutions across specialties to answer an eight-item test on Triad awareness and knowledge. Results A total of 931 physician participants were recorded. Of the total responders (40 % male and 60 % female), 23 % were residents, 12 % were fellows, and 65 % were attending physicians. Overall, 37 % had heard of the Triad. Of these respondents, an average of 2.1 ± 1.1 of the three components were properly identified with an overall average score on the Triad awareness test of 71 ± 18 % out of a possible 100 %. Fifty-one percent reported feeling either comfortable treating or referring a patient with the Triad. When assessing awareness among specialties, the awareness rates were highest among orthopedic surgery (80 %), followed by obstetrics and gynecology (55 %) and physical medicine and rehabilitation/rheumatology (52 %). The three with the lowest awareness were anesthesia (9 %), radiology (10 %), and psychiatry (11 %). Conclusions Our findings suggest that approximately one third of the physicians surveyed have heard of the Triad. Approximately one half of physicians were comfortable treating or referring a patient with the Triad. Increased awareness through education to properly identify and manage the Triad is essential for all physicians.
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Affiliation(s)
- Emily J Curry
- Women's Sports Medicine, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA USA
| | - Catherine Logan
- Women's Sports Medicine, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA USA
| | - Kathryn Ackerman
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA USA
| | - Kelly C McInnis
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA USA
| | - Elizabeth G Matzkin
- Women's Sports Medicine, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA USA ; Harvard Medical School, Boston, MA 02115 USA
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Nieschlag E, Vorona E. MECHANISMS IN ENDOCRINOLOGY: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions. Eur J Endocrinol 2015; 173:R47-58. [PMID: 25805894 DOI: 10.1530/eje-15-0080] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/24/2015] [Indexed: 01/30/2023]
Abstract
Anabolic androgenic steroids (AASs) are appearance and performance-enhancing drugs (APEDs) used in competitive athletics, in recreational sports, and by body-builders. The global lifetime prevalence of AASs abuse is 6.4% for males and 1.6% for women. Many AASs, often obtained from the internet and dubious sources, have not undergone proper testing and are consumed at extremely high doses and in irrational combinations, also along with other drugs. Controlled clinical trials investigating undesired side effects are lacking because ethical restrictions prevent exposing volunteers to potentially toxic regimens, obscuring a causal relationship between AASs abuse and possible sequelae. Because of the negative feedback in the regulation of the hypothalamic-pituitary-gonadal axis, in men AASs cause reversible suppression of spermatogenesis, testicular atrophy, infertility, and erectile dysfunction (anabolic steroid-induced hypogonadism). Should spermatogenesis not recover after AASs abuse, a pre-existing fertility disorder may have resurfaced. AASs frequently cause gynecomastia and acne. In women, AASs may disrupt ovarian function. Chronic strenuous physical activity leads to menstrual irregularities and, in severe cases, to the female athlete triad (low energy intake, menstrual disorders and low bone mass), making it difficult to disentangle the effects of sports and AASs. Acne, hirsutism and (irreversible) deepening of the voice are further consequences of AASs misuse. There is no evidence that AASs cause breast carcinoma. Detecting AASs misuse through the control network of the World Anti-Doping Agency (WADA) not only aims to guarantee fair conditions for athletes, but also to protect them from medical sequelae of AASs abuse.
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Affiliation(s)
- Eberhard Nieschlag
- Centre of Reproductive Medicine and AndrologyUniversity of Münster, 48129 Münster, GermanyCenter of Excellence in Genomic Medicine ResearchKing Abdulaziz University, Jeddah, Saudi ArabiaCentre of EndocrinologyDiabetology and Rheumatology, Dortmund, Germany Centre of Reproductive Medicine and AndrologyUniversity of Münster, 48129 Münster, GermanyCenter of Excellence in Genomic Medicine ResearchKing Abdulaziz University, Jeddah, Saudi ArabiaCentre of EndocrinologyDiabetology and Rheumatology, Dortmund, Germany
| | - Elena Vorona
- Centre of Reproductive Medicine and AndrologyUniversity of Münster, 48129 Münster, GermanyCenter of Excellence in Genomic Medicine ResearchKing Abdulaziz University, Jeddah, Saudi ArabiaCentre of EndocrinologyDiabetology and Rheumatology, Dortmund, Germany
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The Prevalence of and Attitudes Toward Oligomenorrhea and Amenorrhea in Division I Female Athletes. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY & TRAINING 2014. [DOI: 10.1123/ijatt.2014-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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28
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Maïmoun L, Georgopoulos NA, Sultan C. Endocrine disorders in adolescent and young female athletes: impact on growth, menstrual cycles, and bone mass acquisition. J Clin Endocrinol Metab 2014; 99:4037-50. [PMID: 24601725 DOI: 10.1210/jc.2013-3030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Puberty is a crucial period of dramatic hormonal changes, accelerated growth, attainment of reproductive capacity, and acquisition of peak bone mass. Participation in recreational physical activity is widely acknowledged to provide significant health benefits in this period. Conversely, intense training imposes several constraints, such as training stress and maintenance of very low body fat to maximize performance. Adolescent female athletes are therefore at risk of overtraining and/or poor dietary intake, which may have several consequences for endocrine function. The "adaptive" changes in the hypothalamic-pituitary-gonadal, -adrenal, and somatotropic axes and the secretory role of the adipose tissue are reviewed, as are their effects on growth, menstrual cycles, and bone mass acquisition. DESIGN A systematic search on Medline between 1990 and 2013 was conducted using the following terms: "intense training," "physical activity," or "exercise" combined with "hormone," "endocrine," and "girls," "women," or "elite female athletes." All articles reporting on the endocrine changes related to intense training and their potential implications for growth, menstrual cycles, and bone mass acquisition were considered. RESULTS AND CONCLUSION Young female athletes present a high prevalence of menstrual disorders, including delayed menarche, oligomenorrhea, and amenorrhea, characterized by a high degree of variability according to the type of sport. Exercise-related reproductive dysfunction may have consequences for growth velocity and peak bone mass acquisition. Recent findings highlight the endocrine role of adipose tissue and energy balance in the regulation of homeostasis and reproductive function. A better understanding of the mechanisms whereby intense training affects the endocrine system may orient research to develop innovative strategies (ie, based on nutritional or pharmacological approaches and individualized modalities of training and competition) to improve the medical care of these adolescents and protect their reproductive function.
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Affiliation(s)
- Laurent Maïmoun
- Service de Médecine Nucléaire (L.M.), Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) de Montpellier and Université Montpellier 1 (UM1), 34295 Montpellier, France; Département d'Hormonologie (L.M., C.S.), Hôpital Lapeyronie, CHRU Montpellier, 34295 Montpellier, France; Physiologie et Médecine Expérimentale du Cœur et des Muscles (L.M.), INSERM Unité 1046, Université Montpellier 1 (UM1) and Université Montpellier 2 (UM2), 34295 Montpellier, France; Division of Reproductive Endocrinology (N.A.G.), Department of Obstetrics and Gynecology, University of Patras Medical School, University Hospital, Patras 265 04, Greece; and Unité d'Endocrinologie et Gynécologie Pédiatrique (C.S.), Département de Pédiatrie, Hôpital Arnaud de Villeneuve, CHRU Montpellier et UM1, 34295 Montpellier, France
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Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A. Health in older women athletes. Maturitas 2014; 79:357-61. [PMID: 25281439 DOI: 10.1016/j.maturitas.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/06/2014] [Indexed: 11/18/2022]
Abstract
Physical activity has been identified as a protective factor against a wide spectrum of diseases, but little is known about the link between older women's health and their professional involvement in sport in the past. The aim of this narrative review is to characterize and summarize the available data concerning the influence of physical activity on morbidity and mortality in former female athletes. Concerning bone health, it seems that physical activity in the past can be protective against osteoporosis in postmenopausal women, but these data come from observational studies only. Also the cardiovascular system appears to benefit in older women from regular sport in the past. This refers mainly to better heart efficiency, and improved endothelial function and metabolic profile. The incidence of different types of neoplasms, especially breast cancer, is also decreased in former athletes. Professional sport, on the other hand, acts negatively on the pelvic floor and is a risk factor for urinary incontinence. The overall effect on mortality is difficult to assess, because of many parameters, such as the sport's intensity, variety of the sport and exposure to extreme danger in some disciplines. Also, caution should be kept in interpretation of the data because of the shortage of well-designed studies.
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Affiliation(s)
- Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland.
| | - Krzysztof Katulski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
| | - Adam Czyzyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
| | - Agnieszka Podfigurna-Stopa
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
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Abstract
PURPOSE OF REVIEW Female participation in athletics has increased significantly over the past several decades. For most young women, participation in sport fosters self-confidence, positive relationships with peers, and good physical health. However, with growing female representation in athletics, the sport community has become increasingly aware of the syndrome known as 'female athlete triad,' which describes the interplay between low energy availability (LEA), menstrual disturbances, and decreased bone mineral density (BMD). This review aims to discuss the definition and prevalence of the triad and prevention, detection, and treatment strategies. RECENT FINDINGS Current research has elucidated the importance of identifying and treating the triad in young athletes, as adolescence is a critical time for bone development and failure to intervene can lead to long-term problems. First defined in 1992, full characterization of the triad in adolescents has been elusive because of difficulties in diagnosing low BMD in this population and reliance on self-report for menstrual disturbances and LEA. A 2007 reformulation of the triad incorporated research demonstrating that the full deleterious triad is rare and emphasized that its components exist on a spectrum. Removal of the stigma from the triad has the potential to allow earlier detection and treatment, thereby improving outcomes. SUMMARY The female athlete triad is a problem with important long-term consequences. Education should be geared toward athletes as well as coaches, athletic trainers, school nurses, primary care providers, and others involved in female athletics to allow early identification and intervention.
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Abstract
Synchronized skating is a unique sport of team skating and currently represents the largest competitive discipline in U.S. Figure Skating. Synchronized skating allows skaters to compete as part of a team with opportunities to represent their country in international competitions. As the popularity of the sport continues to grow, more of these athletes will present to sports medicine clinics with injuries and illnesses related to participation in synchronized skating. The purpose of this article is to review the common injuries and medical conditions affecting synchronized skaters.
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Affiliation(s)
- Kristin Abbott
- 1 Northwestern University Health Service, IL; and 2 Primary Care Sports Medicine Fellowship, Department of Family Medicine and Community Health, University of Minnesota, 2525 University Ave SE, Minneapolis, MN
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Kransdorf LN, Vegunta S, Files JA. Everything in Moderation: What the Female Athlete Triad Teaches Us About Energy Balance. J Womens Health (Larchmt) 2013; 22:790-2. [DOI: 10.1089/jwh.2013.4515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lisa N. Kransdorf
- Division of Women's Health–Internal Medicine, Mayo Clinic in Arizona, Scottsdale, Arizona
| | - Suneela Vegunta
- Division of Women's Health–Internal Medicine, Mayo Clinic in Arizona, Scottsdale, Arizona
| | - Julia A. Files
- Division of Women's Health–Internal Medicine, Mayo Clinic in Arizona, Scottsdale, Arizona
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