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Smith A, Buadze A, Colangelo J, Liebrenz M. A Review of Mental Health Issues in High-Performance and Elite-Level Cycling. Int J Sports Med 2023; 44:1034-1042. [PMID: 37524113 DOI: 10.1055/a-2145-6355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Despite the public health benefits of cycling in the general population, mental health issues may be evident in high-performance and elite-level competitive domains. With prominent riders disclosing their experiences with psychiatric symptoms, distinctive socioenvironmental factors could exacerbate psychopathological vulnerabilities. This suggests a need for greater mental health awareness amongst stakeholders, supplemented by actions from international and national federations and regulators. To synthesise relevant observations about psychiatric concerns in high-performance and elite-level cycling, we conducted a keyword search of articles in APA PsycINFO, PubMed, and Scopus based on specified exclusion criteria. Thirteen papers were identified that examined mental health issues in high-performance and/or elite-level cycling per classifications from the World Health Organization's International Classification of Diseases 11th Revision. A large proportion of articles illustrated eating disorder symptomatology, but others discussed attention deficit/hyperactivity disorder, anxiety disorder, depression, sleep wake disorders, and substance use disorder. Existing literature underlines important considerations for all stakeholders within the cycling community around mental health initiatives and care provisions, which are currently lacking across the sport. Such programmes could incorporate consensus statements, psychiatric screening, psychoeducation, stigma-reducing policies, and athlete advocacy. These can help mitigate socioenvironmental risk factors and prioritise athlete wellbeing over performance-centred motivations.
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Affiliation(s)
- Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | - Ana Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Jill Colangelo
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
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Colangelo J, Smith A, Buadze A, Liebrenz M. "There just isn't any other option-so we just have to put up with it": mental health in women's cycling and the necessity of structural change. Front Sports Act Living 2023; 5:1270957. [PMID: 38033654 PMCID: PMC10687357 DOI: 10.3389/fspor.2023.1270957] [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: 08/01/2023] [Accepted: 10/10/2023] [Indexed: 12/02/2023] Open
Abstract
Historically, bicycle riding connoted freedom, independence, and enhanced mental and physical wellbeing for women. Persevering through criticism and moral panic, female cyclists have been competitive since the late 19th century-many earning substantial prize money and prestige. Unfortunately, this progress was not linear in its trajectory and contemporary professional women's cycling continues to be pervaded by structural and cultural challenges, which can have deleterious effects on athlete mental health. Notably, socioeconomic pressures endure, like unstable employment terms, limited team support, and role conflicts. Furthermore, sexual harassment, body shaming, and manipulation may characterize women's experiences with their coaches and teams. Sizable investment gaps between men's and women's teams and competitions often underpin these scenarios of disadvantage. Alongside hindering the development of women's cycling, these adverse circumstances may induce psychosocial risk factors. Within this context, by highlighting sport-specific and sex-specific considerations, the emerging subdiscipline of sports psychiatry can be valuable for protecting and promoting athlete welfare in women's cycling. Raising awareness about extant symptoms, vulnerabilities, contributing behaviours, and systemic issues, can bolster efforts to develop better conditions and care equivalence. To that end, this perspective article draws upon anecdotal and scholarly evidence to provide an overview of psychiatric concerns in women's professional cycling. This informs recommended strategies to improve mental health and advance equality within the sport, which should involve actions from several stakeholders, such as athletes, teams, and governing bodies.
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Affiliation(s)
- Jill Colangelo
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | - Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | - Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
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Redinger AL, Baker BS. Oral Contraceptives and Female Rowers' Skeletal Health. J Strength Cond Res 2023; 37:669-677. [PMID: 36165993 DOI: 10.1519/jsc.0000000000004308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Redinger, AL and Baker, BS. Oral contraceptives and female rowers' skeletal health. J Strength Cond Res 37(3): 669-677, 2023-Previous studies suggest that women using oral contraceptives (OC) experience fewer skeletal benefits from exercise compared with non-OC users. These findings may be especially important for athletes competing in weight-supported sports with a high prevalence of low bone mineral density and fracture, such as rowing. The purpose of this study was to examine skeletal health and bone injuries in collegiate female rowers. Forty-nine National Collegiate Athletic Association Division I female rowers completed general health, menstrual history, and bone physical activity questionnaire (BPAQ) surveys. Dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) scans were used to assess bone content, density, and geometry. Contraceptive (OC users n = 14, non-OC users n = 35) and self-reported stress fracture (SFx n = 11, None n = 38) groups were analyzed using analysis of covariance and independent t -tests. Additionally, effect sizes ( d ) were calculated and significance was set at p ≤ 0.05. Oral contraceptive users had reduced lumbar spine areal bone mineral density after adjustment for Total BPAQ ( d = 0.58; p = 0.041) compared with non-OC users, but all other total body and site-specific DXA measures of bone mineral content and density were similar between contraceptive and injury groups. When comparing bone geometry of the 4, 38, and 66% tibiae using pQCT, no significant differences were found after adjustment for either contraceptive or injury group (all p > 0.060). Our findings suggest that OC usage was not associated with reduced skeletal health in competitive female rowers as evidenced by all Z-scores being above -2.0 and similar bone indices of mineralized content, density, geometry, and estimated strength between the groups.
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Affiliation(s)
- Allen L Redinger
- Musculoskeletal Adaptations to Aging and exercise (MAAX) Lab, School of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, Oklahoma
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Roberts CJ, Hurst HT, Hardwicke J. Eating Disorders and Disordered Eating in Competitive Cycling: A Scoping Review. Behav Sci (Basel) 2022; 12:bs12120490. [PMID: 36546973 PMCID: PMC9774887 DOI: 10.3390/bs12120490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
This article reports on the findings from a scoping review on eating disorders and disordered eating in competitive cycling. The review was informed by a scoping review methodological framework as well as the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) reporting guidelines. PubMed, SPORTDiscus and Web of Science were used to identify relevant literature for review. Fourteen studies met the eligibility criteria and were included in the full review. A narrative synthesis was used to summarise the main findings and themes across the included literature. Findings from the review are presented under the following themes: cycling as an 'at-risk' discipline; power to weight ratio; energy requirements and risk of low energy availability; the social environment of cycling; nutrition support provision; relationship between eating disorders/disordered eating and exercise addiction; and recommendations made in identified literature. Overall, the literature suggests competitive cycling is a sport with a high prevalence of disordered eating and/or eating disorders and a sport with unique risk factors that contribute to this. Crucially, more research is needed in this area. The article concludes with the gaps in the literature highlighted, implications for future research, and applications to policy and practice suggested.
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Affiliation(s)
- Charlie Jon Roberts
- Centre for Physical Activity and Life Sciences, University of Northampton, Northampton NN1 5PH, UK
- Correspondence:
| | - Howard Thomas Hurst
- Centre for Applied Sport Physical Activity and Performance, University of Central Lancashire, Preston PR1 2HE, UK
| | - Jack Hardwicke
- Centre for Physical Activity and Life Sciences, University of Northampton, Northampton NN1 5PH, UK
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Gimunová M, Paulínyová A, Bernaciková M, Paludo AC. The Prevalence of Menstrual Cycle Disorders in Female Athletes from Different Sports Disciplines: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114243. [PMID: 36361122 PMCID: PMC9658102 DOI: 10.3390/ijerph192114243] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/28/2022] [Accepted: 10/10/2022] [Indexed: 05/05/2023]
Abstract
The aim of this study was to rapidly review the literature on the prevalence of menstrual disorders in female athletes from different sports modalities. Articles were searched in the Web of Science and PubMed database in May 2022. A total of 1309 records were identified, and 48 studies were included in the final stage. The menstrual disorders described in the included studies were primary (in 33% of included studies) and secondary amenorrhea (in 73% of included studies) and oligomenorrhea (in 69% of included studies). The prevalence of menstrual disorders among the studies ranged from 0 to 61%. When data were pooled according to discipline (mean calculation), the highest prevalence of primary amenorrhea was found in rhythmic gymnastics (25%), soccer (20%) and swimming (19%); for secondary amenorrhea in cycling (56%), triathlon (40%) and rhythmic gymnastics (31%); and oligomenorrhea in boxing (55%), rhythmic gymnastics (44%) and artistic gymnastics (32%). Based on the results of this review, the study supports the literature of the higher prevalence of menstrual disorders in gymnastics and endurance disciplines. However, team sports modalities such as volleyball and soccer also presented a considerable percentage of menstrual disorders compared to the general population. It reinforces the importance of coaches and physicians paying attention to athletes' menstrual cycle as the occurrence of menstrual disorders can be associated with impairment on some health components.
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Affiliation(s)
- Marta Gimunová
- Department of Kinesiology, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
- Correspondence:
| | - Alexandra Paulínyová
- Department of Kinesiology, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
| | - Martina Bernaciková
- Department of Kinesiology, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
| | - Ana Carolina Paludo
- Incubator of Kinanthropological Research, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
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Reduced Endurance Capacity and Suboptimal Energy Availability in Top-Level Female Cyclists. Int J Sports Physiol Perform 2021; 16:1194–1203. [PMID: 33626509 DOI: 10.1123/ijspp.2020-0513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/11/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Women's professional cycling has grown in popularity, and this increase is also apparent in Brazil, which has increased its female cycling calendar in recent years. The aim of this observational study was to (1) determine training and competition loads of a top-level Brazilian female cycling team, (2) evaluate nutrition and clinical health, and (3) measure whether exercise capacity changed throughout the season. METHODS Training and competition data were collected over the season using global positioning system monitors, while laboratory-based physiological and performance measures (incremental cycling test, 30-s Wingate, 4-km time trial) and clinical and nutritional analyses were performed at time points throughout the season. RESULTS Total distance covered over the year was 11,124 (2895) km (7382-14,698 km). Endurance capacity was reduced over the season (P = .005) but not anaerobic power (all P > .05). Nutrition and stress markers remained largely unchanged throughout the season, although there were some individual fluctuations in some measures, and testosterone concentration was low for some. Median estimated energy availability ranged between 32.3 and 56.8 kcal·kgLBM-1·d-1 during training and 26.4 and 53.8 kcal·kgLBM-1·d-1 during competition. Percentage of training spent in optimal estimated energy availability was generally low, with 3 athletes spending <35% within the optimal intake. CONCLUSIONS Substantial training and competition loads of the monitored professional Brazilian female cyclists may have reduced exercise capacity toward the end of the season, indicative of a grueling yearlong schedule. Several athletes may have had suboptimal energy availability during the season, potentially affecting testosterone concentration. These data demonstrate the difficulties in maintaining optimal nutrition, health, and performance throughout a season in professional female cycling and highlight the need for quality sport-science support for this type of top-level athlete.
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Heather AK, Thorpe H, Ogilvie M, Sims ST, Beable S, Milsom S, Schofield KL, Coleman L, Hamilton B. Biological and Socio-Cultural Factors Have the Potential to Influence the Health and Performance of Elite Female Athletes: A Cross Sectional Survey of 219 Elite Female Athletes in Aotearoa New Zealand. Front Sports Act Living 2021; 3:601420. [PMID: 33681758 PMCID: PMC7932044 DOI: 10.3389/fspor.2021.601420] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/26/2021] [Indexed: 11/25/2022] Open
Abstract
Health is a pre-requisite for optimal performance yet the parameters which govern health and performance of elite female athletes are little understood. The aim of this study was to quantify the health status of elite female athletes, and understand sociocultural factors influencing that status. The survey addressed demographic, health and athletic performance history, training load, contraceptive use, sport-specific appearance and performance pressures, and communication barriers. Three hundred and fifty-seven elite New Zealand female athletes were recruited to complete an on-line survey. Two hundred and nineteen athletes completed the survey. Oligomenorrhea/amenorrhea had been diagnosed in only 12% of athletes compared with 50% of athletes not on hormonal contraception who reported symptoms consistent with this diagnosis. Stress fractures and iron deficiency were common and associated with oligomenorrhoea/amenorrhea (P = 0.002), disordered eating (P = 0.009) or menorrhagia (P = 0.026). Athletes involved in individual sports (P = 0.047) and with higher training volumes (P < 0.001) were more likely to report a medical illness. Seventy-three percent of athletes felt pressured by their sport to alter their physical appearance to conform to gender ideals with 15% engaging in disordered eating practices. Barriers to communicating female health issues included male coaches and support staff, and lack of quality information pertaining to health. Elite female athletes may fail to reach peak performance due to specific health issues and undiagnosed pathology. Sociocultural factors influence the effectiveness of support of female's health and performance. Organizational and cultural change is required if elite female athletes are to combine optimal health with best performance.
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Affiliation(s)
- Alison K Heather
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.,WHISPA Group, High Performance Sport New Zealand, Auckland, New Zealand
| | - Holly Thorpe
- WHISPA Group, High Performance Sport New Zealand, Auckland, New Zealand.,School of Health, University of Waikato, Hamilton, New Zealand
| | - Megan Ogilvie
- WHISPA Group, High Performance Sport New Zealand, Auckland, New Zealand.,Fertility Associates, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| | - Stacy T Sims
- WHISPA Group, High Performance Sport New Zealand, Auckland, New Zealand.,School of Health, University of Waikato, Hamilton, New Zealand
| | - Sarah Beable
- WHISPA Group, High Performance Sport New Zealand, Auckland, New Zealand.,Axis Sports Medicine, Auckland, New Zealand.,High Performance Sport New Zealand, Auckland, New Zealand
| | - Stella Milsom
- WHISPA Group, High Performance Sport New Zealand, Auckland, New Zealand.,Fertility Associates, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand.,Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Katherine L Schofield
- WHISPA Group, High Performance Sport New Zealand, Auckland, New Zealand.,School of Health, University of Waikato, Hamilton, New Zealand
| | - Lynne Coleman
- WHISPA Group, High Performance Sport New Zealand, Auckland, New Zealand.,High Performance Sport New Zealand, Auckland, New Zealand
| | - Bruce Hamilton
- WHISPA Group, High Performance Sport New Zealand, Auckland, New Zealand.,High Performance Sport New Zealand, Auckland, New Zealand.,Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
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Hoon MW, Haakonssen EC, Menaspà P, Burke LM. Racing weight and resistance training: perceptions and practices in trained male cyclists. PHYSICIAN SPORTSMED 2019; 47:421-426. [PMID: 30978146 DOI: 10.1080/00913847.2019.1607602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: This study sought to investigate the perceptions and practices of achieving 'race weight' in a population of trained male cyclists. A secondary focus was to investigate the use of gym-based strength training, a possible attenuator of the side effects associated with weight reduction.Methods: A total of n = 97 well-trained cyclists ranging from local club level to international standard completed an online survey capturing data on the aforementioned topics.Results: Forty-nine percent of respondents indicated they were unsatisfied with their current bodyweight, with a similar percentage across club, national and international level riders. Riders who identified as climbers had lower reported bodyweight; however, all categories of riders expressed a desire to reduce bodyweight by a similar percentage (1.9%, ± 3.4%; 90% CL). Seventy-seven percent of respondents indicated that they had recently tried or were currently trying to reduce bodyweight, most commonly by reducing food intake and avoiding sugary foods. Nine percent indicated they were using either supplements or medications to lower bodyweight, and 27% reported having sought advice from a health professional. A higher proportion of international riders engaged in strength training (85%), compared to national (50%) and club (55%) riders (p< 0.05). The most cited reasons for not strength training were time constraints and believing it was not beneficial to their cycling performance.Conclusion: These data suggest that trained male cyclists are a highly weight-conscious population who engage in a variety of practices to reduce weight. Practitioners should be aware of these tendencies, as they may carry significant health implications if poorly implemented.
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Affiliation(s)
- Matthew W Hoon
- School of School of Behavioural and Health Sciences, Australian Catholic University, Canberra, Australia
| | - Eric C Haakonssen
- Cycling Australia, Adelaide, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Paolo Menaspà
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Louise M Burke
- Sports Nutrition, Australian Institute of Sport, Canberra, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Canberra, Australia
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Keay N, Francis G, Hind K. Low energy availability assessed by a sport-specific questionnaire and clinical interview indicative of bone health, endocrine profile and cycling performance in competitive male cyclists. BMJ Open Sport Exerc Med 2018; 4:e000424. [PMID: 30364549 PMCID: PMC6196965 DOI: 10.1136/bmjsem-2018-000424] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 12/29/2022] Open
Abstract
Objectives To evaluate the efficacy of a sport-specific energy availability (EA) questionnaire, combined with clinical interview, for identifying male athletes at risk of developing bone health, endocrine and performance consequences of relative energy deficiency in sports (RED-S). Methods Fifty competitive male road cyclists, recruited through links of participants in a pilot study, were assessed by a newly developed sport-specific questionnaire and clinical interview (SEAQ-I) and received dual energy X-ray absorptiometry (DXA) bone mineral density (BMD) and body composition scans and blood tests for endocrine markers. Results Low EA as assessed using the SEAQ-I, was observed in 28% of cyclists. Low lumbar spine BMD (Z-score<−1.0) was found in 44% of cyclists. EA was the most significant determinant of lumbar spine BMD Z-score (p<0.001). Among low EA cyclists, lack of previous load-bearing sport was associated with the lowest BMD (p=0.013). Low EA was associated with reduced total percentage fat (p<0.019). The 10 cyclists with chronic low EA had lower levels of testosterone compared with those having adequate EA (p=0.024). Mean vitamin D concentration was below the level recommended for athletes (90 nmol/L). Training loads were positively associated with power-to-weight ratios, assessed as 60 min functional threshold power (FTP) per kg (p<0.001). Percentage body fat was not significantly linked to cycling performance. Conclusions This study demonstrates that a SEAQ-I is effective for identifying male road cyclists with acute intermittent and chronic sustained low EA. Cyclists with low EA, particularly in the long-term, displayed adverse quantifiable measures of bone, endocrinology and performance consequences of RED-S.
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Affiliation(s)
- Nicola Keay
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | | | - Karen Hind
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
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Haakonssen EC, Barras M, Burke LM, Jenkins DG, Martin DT. Body composition of female road and track endurance cyclists: Normative values and typical changes. Eur J Sport Sci 2015; 16:645-53. [PMID: 26366462 DOI: 10.1080/17461391.2015.1084538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aims of this study were to describe normative values and seasonal variation of body composition in female cyclists comparing female road and track endurance cyclists, and to validate the use of anthropometry to monitor lean mass changes. Anthropometric profiles (seven site skinfolds) were measured over 16 years from 126 female cyclists. Lean mass index (LMI) was calculated as body weight × skinfolds(-x). The exponent (x) was calculated as the slope of the natural logarithm of body weight and skinfolds. Percentage changes in LMI were compared to lean mass changes measured using dual-energy X-ray absorptiometry (DXA) in a subset of 25 road cyclists. Compared to sub-elite and elite cyclists, world class cyclists were (mean [95% CI]) 1.18 kg [0.46, 1.90] and 0.60 kg [0.05, 1.15] lighter and had skinfolds that were 7.4 mm [3.8, 11.0] and 4.6 mm [1.8, 7.4] lower, respectively. Body weight (0.41 kg [0.04, 0.77]) and skinfolds (4.0 mm [2.1, 6.0]) were higher in the off-season compared to the early-season. World class female road cyclists had lower body weight (6.04 kg [2.73, 9.35]) and skinfolds (11.5 mm [1.1, 21.9]) than track endurance cyclists. LMI (mean exponent 0.15 [0.13, 0.18]) explained 87% of the variance in DXA lean mass. In conclusion, higher performing female cyclists were lighter and leaner than their less successful peers, road cyclists were lighter and leaner than track endurance cyclists, and weight and skinfolds were lowest early in the season. LMI appears to be a reasonably valid tool for monitoring lean mass changes.
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Affiliation(s)
- Eric C Haakonssen
- a Physiology , Australian Institute of Sport , Belconnen , ACT , Australia.,b High Performance Unit , Cycling Australia , Enfield Plaza , SA , Australia.,c Human Movement and Nutrition Sciences , University of Queensland , St Lucia , QLD , Australia
| | - Martin Barras
- b High Performance Unit , Cycling Australia , Enfield Plaza , SA , Australia
| | - Louise M Burke
- d Sports Nutrition , Australian Institute of Sport , Belconnen , ACT , Australia.,e School of Exercise Science , Australian Catholic University , Melbourne , VIC , Australia
| | - David G Jenkins
- c Human Movement and Nutrition Sciences , University of Queensland , St Lucia , QLD , Australia
| | - David T Martin
- a Physiology , Australian Institute of Sport , Belconnen , ACT , Australia
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