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Witkoś J, Luberda E, Błażejewski G, Strój E. Menstrual cycle disorders as an early symptom of energy deficiency among female physique athletes assessed using the Low Energy Availability in Females Questionnaire (LEAF-Q). PLoS One 2024; 19:e0303703. [PMID: 38848428 PMCID: PMC11161107 DOI: 10.1371/journal.pone.0303703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/29/2024] [Indexed: 06/09/2024] Open
Abstract
Physique competitions are weight-sensitive sports in which stage presentation, aesthetic appearance and posing ability of the athletes are judged rather than physical performance. The aim of this study was to assess low energy availability among female physique athletes by using the LEAF-Q. The study involved 104 females who were physique athletes. Monthly cycle disorders were reported in 58.65% of the women, that is periods stopped for three consecutive months or longer (amenorrhea). This situation occurred before the research was conducted in 43.27% of athletes and during the research in 15.38%. The physique athletes claimed that menstruation changes occurred when there was an increased exercise intensity, frequency or duration. Absence from training due to injury was reported by 27.88% of the women. The LEAF-Q identified 46.15% of the physique athletes as at risk (score ≥ 8) of low energy availability and the physiological consequences related to RED-S. Women who had menstrual cycle disorders were younger and did more training per week. Among women with menstrual disorders, cramps or stomach ache which cannot be related to menstruation occurred more frequently (p = 0.004). Absence from training or lack of participation in competition due to injuries occurred more frequently in the score ≥ 8 group (p = 0.024) thank the ≤ score 8 group. In the score ≥ 8 group menstruation changes, that is less bleeding or cessation of menstruation (p = 0.035), occurred more frequently when there was an increase in exercise intensity, frequency or duration (p = 0.002).
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Affiliation(s)
- Joanna Witkoś
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Edyta Luberda
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Grzegorz Błażejewski
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Ewa Strój
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
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Critchley ML, Toomey C, Gabel L, Kenny SJ, Emery CA. Differences in bone mineral density and associated factors in dancers and other female athletes. Appl Physiol Nutr Metab 2024. [PMID: 38691851 DOI: 10.1139/apnm-2023-0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Dancers are susceptible to relative energy deficiency in sport (RED-S), specifically low bone mineral density (BMD). Little is known about how dancers' BMD compares to other athletic populations. The objective of this study was to examine the association between participant characteristics and total body areal BMD (aBMD) among female pre-professional dancers compared to other female athletes. Two hundred sixty-nine females (132 pre-professional dancers (17.6 (3.2) years) and 137 sport participants (22.8 (2.6) years) were included in this study. aBMD (g/cm2) was estimated using dual X-ray absorptiometry. Multivariable linear regression was used to examine the association between height-adjusted z-scores of total body aBMD (aBMD-Z) and age (years), body mass index (BMI) (z-score), supplement intake, history of stress fracture, irregular menses, MRI/bone scan, 1-year injury history, oral contraceptives, and activity (dance/sport). Total body aBMD and aBMD-Z were lower in dancers than athletes (dancers: aBMD = 1.03 g/cm2 (95% CI: 1.01, 1.05); aBMD-Z = -0.28 (-0.43, -0.12) (p < 0.001); athletes: aBMD = 1.14 g/cm2 (95% CI: 1.12, 1.16); aBMD-Z = 0.41 (0.25, 0.57) (p < 0.001)). aBMD-Z increased with age (β = 0.054, 95% CI: 0.017, 0.092; p = 0.004) and BMI (β = 0.221, 95% CI: 0.006, 0.415; p = 0.043). Activity type modified the relationship between BMI and aBMD-Z (β = 0.323, 95% CI: 0.025, 0.621; p < 0.033) with a stronger positive association in dancers, compared to other female athletes. Dancers had lower total body aBMD and aBMD-Z than other female athletes. aBMD-Z increases with age in female pre-professional dancers and other female athletes. A stronger association exists between aBMD-Z and BMI in dancers than athletes. Future studies should consider changes in aBMD-Z during adolescence and associations with increased risk of bone injury.
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Affiliation(s)
- Meghan L Critchley
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Clodagh Toomey
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Leigh Gabel
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Sarah J Kenny
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- School of Creative and Performing Arts, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Thuany M, Viljoen C, Gomes TN, Knechtle B, Scheer V. Mental Health in Ultra-Endurance Runners: A Systematic Review. Sports Med 2023; 53:1891-1904. [PMID: 37535248 DOI: 10.1007/s40279-023-01890-5] [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: 07/03/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Among ultra-endurance runners (UER), the mental, behavioral, and physical demands of training/competition can result in maladaptive outcomes. Mental health issues are common in athletes and can impact psychology, physical health, and performance. OBJECTIVE To synthesize information regarding the incidence/prevalence and factors associated with mental health issues among UER. METHODS Systematic searches were performed in PubMed, SPORTDiscus, Scopus, Cochrane databases, CINAHL, Web of Science, and Medline Ovid using key terms related to UER (e.g., trail running, road running) and psychological issues (e.g., exercise addiction, depression). Inclusion criteria included original articles published in peer-reviewed journals in English, using qualitative or quantitative approaches. We considered papers reporting incidence/prevalence and associated factors with mental health outcomes in UER of both sexes, all ages, and levels of competition (e.g., elite, nonprofessional runners). The Joanna Briggs Institute Analytical Cross-Sectional Studies critical appraisal tool was used for quality assessment. RESULTS A total of 282 studies were identified, and 11 studies were included in the final selection. A total of 3670 UER were included in the studies. The prevalence of mental health issues among UER ranged between 32.0% and 62.5% for eating disorders, from 11.5% to 18.2% for exercise addiction, 18.6% for depressive symptoms, and 24.5% for sleep disturbance. Exercise addiction was not related to weekly volume, but a strong relationship with exercise in an unstructured space, age, and body mass index was shown. CONCLUSION Mental health issues among UER are common, especially eating disorders, exercise addiction, sleep disturbances, and depressive symptoms. Further high-quality studies are needed to examine underlying factors and find preventative strategies to protect UER. REGISTRATION The protocol of this systematic review was registered at the PROSPERO-CRD42022338743.
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Affiliation(s)
- Mabliny Thuany
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal.
| | - Carel Viljoen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Thayse Natacha Gomes
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Physical Education, Federal University of Sergipe, São Cristóvão, Brazil
| | - Beat Knechtle
- Medbase St. Gallen am Vadianplatz, St. Gallen, Switzerland
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Volker Scheer
- Ultra Sports Science Foundation, Pierre-Bénite, France
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Armento AM, VanBaak KD, Seehusen CN, Howell DR. Differences in Training and Health Characteristics Between Trail Ultrarunners and Shorter Distance Runners. Wilderness Environ Med 2023; 34:182-186. [PMID: 36764885 DOI: 10.1016/j.wem.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/08/2022] [Accepted: 12/01/2022] [Indexed: 02/10/2023]
Abstract
INTRODUCTION The primary aim of the study was to compare select training and health characteristics between ultramarathon and shorter distance runners participating in a trail race series. METHODS A questionnaire was sent to all participants who signed up for a trail race series, including distances of 10 km, half marathon, 50 km, 80.5 km (50 mi), and 100 km. There were 59 participants (27 ultramarathoners and 32 half marathon/10-km runners) who completed the questionnaire. We compared the training and health characteristics between groups using t tests and Fisher exact tests. RESULTS There were no significant differences in reported history of stress fracture (15% vs 9%; P=0.70) or sleep quality scores (4.4 vs 5.5; P=0.15) between the ultramarathon and half marathon/10-km groups. Over half of both groups reported trying to change body weight to improve performance, without significant differences between groups (65% vs 53%; P=0.42). A significantly greater proportion of the ultramarathoners reported an episode of binge eating in the 4 wk preceding the race (38% vs 3%; P=0.001). CONCLUSIONS Despite differences in training volume, we did not find different injury, sleep, and nutrition data between the ultramarathoners and half marathon/10-km runners, with the exception of more ultramarathoners reporting binging behaviors in the 4 wk leading up to the race. Screening for eating disorder behaviors should be considered in distance runners, particularly ultrarunners.
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Affiliation(s)
- Aubrey M Armento
- Sports Medicine Center, Orthopedics Institute, Children's Hospital Colorado, Aurora, CO; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO.
| | - Karin D VanBaak
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO; Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Corrine N Seehusen
- Sports Medicine Center, Orthopedics Institute, Children's Hospital Colorado, Aurora, CO; University of New England College of Osteopathic Medicine, Biddeford, ME
| | - David R Howell
- Sports Medicine Center, Orthopedics Institute, Children's Hospital Colorado, Aurora, CO; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
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Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review. Sports Med 2021; 52:725-740. [PMID: 34542868 PMCID: PMC8450723 DOI: 10.1007/s40279-021-01561-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 12/14/2022]
Abstract
It is well established that physical activity reduces all-cause mortality and can prolong life. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health.
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Hutson MJ, O'Donnell E, Petherick E, Brooke-Wavell K, Blagrove RC. Incidence of bone stress injury is greater in competitive female distance runners with menstrual disturbances independent of participation in plyometric training. J Sports Sci 2021; 39:2558-2566. [PMID: 34269142 DOI: 10.1080/02640414.2021.1945184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Bone stress injury (BSI) is prevalent in female distance runners. Menstrual disturbances are associated with impaired bone health in endurance athletes. This study aimed to investigate the association between menstrual function and BSI and explore whether plyometric training may protect against BSI in individuals with menstrual disturbances. Competitive female distance runners (n = 183) aged 18-40 years were surveyed for training habits, menstrual function, and BSI, during the previous 12 months. Oligo/amenorrhoea during the previous 12 months (<9 menses) was deemed to indicate menstrual disturbance; hormonal contraceptive users and those previously diagnosed with a pathology that impacted menstrual function were excluded. BSI incidence rate was 2.25 (p = 0.02, 95% CI: 1.14-4.41) times greater in oligo/amenorrhoeic than eumenorrhoeic runners. BSI incidence rate was similar in oligo/amenorrhoeic and eumenorrhoeic runners that did plyometric training, but 3.78 (p = 0.001, 95% CI: 1.68-8.5) times greater in oligo/amenorrhoeic versus eumenorrhoeic runners that did not. However, the effect of plyometrics was non-significant (menstrual function × plyometric training interaction, p = 0.06; main effect, p = 0.89). Conventional plyometric training may not reduce BSI incidence in female distance runners, but menstrual disturbances and prolonged periods of low energy availability should be avoided.
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Affiliation(s)
- Mark J Hutson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma O'Donnell
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emily Petherick
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Richard C Blagrove
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Scheer V, Krabak BJ. Musculoskeletal Injuries in Ultra-Endurance Running: A Scoping Review. Front Physiol 2021; 12:664071. [PMID: 33868030 PMCID: PMC8044296 DOI: 10.3389/fphys.2021.664071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/12/2021] [Indexed: 02/05/2023] Open
Abstract
Ultra-endurance running (UER) has seen an important increase in participation over the last few decades. Long hours of UER can lead to excessive stress on the body, resulting in musculoskeletal injuries (MSKI). UER is not a uniform sport and events can differ considerably in distance (over 42.195 km), time (e.g., events over 6 h) and multi-day or multi-stage events on various surfaces (e.g., track, on-road, off-road). The aims of this scoping review were therefore: (1) to examine the current evidence of MSKI, providing a synthesis of the most common MSKI by anatomical region and specific diagnosis; (2) categorize MSKI by type of UER activity (competition: time-limited; multi-stage; continuous UER events and training); (3) describe knowledge gaps in the literature and provide advice on potential further research. Our electronic literature search (PubMed, SPORTDiscus, Web of Science) identified a total of 13 studies (9 in competition, and 4 in training). Anatomical site, diagnosis and rate of injuries differ between competition and training as well as between different UER types. MSKI are observed in 18% of multi-stage events (0.7-1.8 injuries/runner and 7.2 injuries/1000 h). Most MSKI involve the lower leg (35.0%), ankle (16.8%), knee (13.1%) and foot (12.6%), with main diagnosis of medial tibial stress syndrome (30.1%) and patella femoral pain syndrome (PFPS; 7.2%). Single, continuous UER events differ between a 1005 km road race with almost all of the injuries due to overuse, with the main anatomical site of the knee (31%), ankle (28%) and lower leg (14%) and main diagnosis of PFPS (15.6%), compared to a 65 km trail race, with 32.8% of MSKI, mainly on the foot [plantar fasciitis (28.6%)], ankle [sprain (28.6%)] and knee. Timed-UER events (injury rate of 2.1 injuries/athlete) observed most injuries on the ankle (36%) and knee (19%), with the main diagnosis of tendinitis of the foot dorsiflexors (30%). Injuries during training most commonly affect, the back (42%), and knee (40%) and bone stress injuries (22%). Main diagnoses include ankle sprain (18%), iliotibial band injury (16%) and Achilles tendinopathy (11%). Future considerations include examining MSKI in different UER events, environments and surfaces, and on larger study populations. Establishing risk factors, examining sex differences and using a standard reporting system of MSKI in UER are also important.
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Affiliation(s)
- Volker Scheer
- Ultra Sports Science Foundation, Pierre-Bénite, France
| | - Brian J Krabak
- University of Washington and Seattle Children's Sports Medicine, Seattle, WA, United States
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Abstract
INTRODUCTION Mountain running races have grown in popularity in the recent years. Nonetheless, there are few studies on injuries and injury rates. Moreover, these studies have focused on long-distance events such as ultramarathons (>42 km). Therefore, the aim of the present study was to examine the severity, type, and body location of musculoskeletal injuries during 20-42 km mountain running races. In addition, the injury rates in this type of races were examined. METHODS Data on injuries were collected during 36 mountain running races over 5 consecutive seasons from 2015 to 2019. The participants reported all musculoskeletal injuries on a standardized injury report form. The results were presented as the number of injuries per 1000 h exposure and per 1000 participants. RESULTS Twenty eight injuries were reported. Most injuries occurred in the ankle (32%) followed by the knee (14%) and foot/toe (11%). The number of injuries represented an overall injury rate of 1.6 injuries per 1000 h running and 5.9 injuries per 1000 runners. The case fatality rate was 0. CONCLUSIONS The incidence of musculoskeletal injuries during 20-42 km mountain running races is low. In addition, the majority of injuries experienced by runners are minor in nature and located in lower extremities, mainly the ankles.
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Johnston TE, Dempsey C, Gilman F, Tomlinson R, Jacketti AK, Close J. Physiological Factors of Female Runners With and Without Stress Fracture Histories: A Pilot Study. Sports Health 2020; 12:334-340. [PMID: 32525466 PMCID: PMC7787571 DOI: 10.1177/1941738120919331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Female runners are at increased risk of stress fractures (SFs) compared with men. Literature is lacking with regard to best practice for preventing and treating SFs in women. The purpose of the study was to compare physiological measures and running-related factors between women of various ages and running abilities with and without a history of running-related SFs. HYPOTHESIS Women with and without SF histories will differ with regard to medical and menstrual history, bone health, body composition, nutrition, and running history. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 2. METHODS A total of 20 female runners with SF histories were matched based on age and running distance with 20 women without SF histories. Data included medical, menstrual, running, injury, and nutritional histories; blood histology related to nutritional, hormonal, and bone-related risk factors; and bone density, fat, and lean tissue using dual energy x-ray absorptiometry. Paired t tests were used to examine differences between women with and without SF histories, and Spearmen correlations were conducted to examine relationships between physiological factors. RESULTS Women with SF histories had lower hip bone mineral density compared with women without SF histories (P < 0.05). SF history was moderately correlated with menstrual changes during increased training times (r = 0.580; P < 0.0001) but was not correlated with any other physiological factor. There was a moderate correlation within the SF group (r = 0.65; P = 0.004) for bone markers for resorption and formation both increasing, indicating increased bone turnover. CONCLUSION Female runners with low hip bone mineral density, menstrual changes during peak training, and elevated bone turnover markers may be at increased risk of SF. CLINICAL RELEVANCE Female runners need routine screening for risks associated with SF occurrence. As bone mineral density and bone turnover markers are not routinely assessed in this population, important risk factors may be missed.
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Affiliation(s)
| | | | | | | | | | - Jeremy Close
- Thomas Jefferson University, Philadelphia, Pennsylvania
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10
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Johnston TE, Close J, Jamora P, Wainwright SF. Perceptions of risk for stress fractures: A qualitative study of female runners with and without stress fracture histories. Phys Ther Sport 2020; 43:143-150. [PMID: 32200259 DOI: 10.1016/j.ptsp.2020.02.018] [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: 11/25/2019] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To gain insight into perceived factors related to bone health and stress fracture (SF) prevention for female runners and to understand their experiences within the medical community. DESIGN Cohort qualitative study. SETTING University health system. PARTICIPANTS Forty female runners, 20 who had SF histories and 20 age-and-running-distance matched women without SF. MAIN OUTCOME MEASURES Women participated in audiotaped qualitative semi-structured interviews. For women with a SF history, questions sought their perspectives on factors that they felt contributed to SF, experiences with the medical community, and changes made post SF. For women without a SF history, questions sought perspectives on factors felt important to perceived running-related bone health. RESULTS Six themes emerged; 1) Previous/Recurrent Musculoskeletal Injuries, 2) Activity Patterns and Training Regimens, 3) Nutrition, 4) Prevention and Intervention, 5) Pain, and 6) Mindset. Within these themes, between group differences are characterized by differences in knowledge and/or application of knowledge for health and wellness. Compared to women without SF, women with SF histories increased training load more quickly, had poorer nutrition, performed less cross-training, and kept running despite pain. CONCLUSIONS More education is needed for female runners to decrease risks for SF.
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Affiliation(s)
- Therese E Johnston
- Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Department of Physical Therapy, 901 Walnut St, Philadelphia, PA, 19107, USA.
| | - Jeremy Close
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Family and Community Medicine, 833 Chestnut St, Philadelphia, PA, 19107, USA.
| | - Phil Jamora
- Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Department of Physical Therapy, 901 Walnut St, Philadelphia, PA, 19107, USA.
| | - Susan F Wainwright
- Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Department of Physical Therapy, 901 Walnut St, Philadelphia, PA, 19107, USA.
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Knechtle B, Nikolaidis PT, Zingg MA, Rosemann T, Rüst CA. Half-marathoners are younger and slower than marathoners. SPRINGERPLUS 2016; 5:76. [PMID: 26844023 PMCID: PMC4726642 DOI: 10.1186/s40064-016-1704-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/12/2016] [Indexed: 11/10/2022]
Abstract
Age and performance trends of elite and recreational marathoners are well investigated, but not for half-marathoners. We analysed age and performance trends in 508,108 age group runners (125,894 female and 328,430 male half-marathoners and 10,205 female and 43,489 male marathoners) competing between 1999 and 2014 in all flat half-marathons and marathons held in Switzerland using single linear regression analyses, mixed-effects regression analyses and analyses of variance. The number of women and men increased across years in both half-marathons and marathons. There were 12.3 times more female half-marathoners than female marathoners and 7.5 times more male half-marathoners than male marathoners. For both half-marathons and marathons, most of the female and male finishers were recorded in age group 40-44 years. In half-marathons, women (10.29 ± 3.03 km/h) were running 0.07 ± 0.06 km/h faster (p < 0.001) than men (10.22 ± 3.06 km/h). Also in marathon, women (14.77 ± 4.13 km/h) were running 0.28 ± 0.16 km/h faster (p < 0.001) than men (14.48 ± 4.07 km/h). In marathon, women (42.18 ± 10.63 years) were at the same age than men (42.06 ± 10.45 years) (p > 0.05). Also in half-marathon, women (41.40 ± 10.63 years) were at the same age than men (41.31 ± 10.30 years) (p > 0.05). However, women and men marathon runners were older than their counterpart half-marathon runners (p < 0.001). In summary, (1) more athletes competed in half-marathons than in marathons, (2) women were running faster than men, (3) half-marathoners were running slower than marathoners, and (4) half-marathoners were younger than marathoners.
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Affiliation(s)
- Beat Knechtle
- Gesundheitszentrum St. Gallen, St. Gallen, Switzerland ; Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Pantelis T Nikolaidis
- Department of Physical and Cultural Education, Hellenic Army Academy, Athens, Greece
| | - Matthias A Zingg
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Christoph A Rüst
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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Folscher LL, Grant CC, Fletcher L, Janse van Rensberg DC. Ultra-Marathon Athletes at Risk for the Female Athlete Triad. SPORTS MEDICINE-OPEN 2015; 1:29. [PMID: 26380807 PMCID: PMC4564455 DOI: 10.1186/s40798-015-0027-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/12/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Worldwide female participation in ultra-endurance events may place them at risk for the female athlete triad (FAT). The study objectives were to establish triad knowledge, occurrence of disordered eating and triad risk amongst participants of the 2014 89-km Comrades Marathon event. METHODS A survey utilising the Low Energy Availability in Females questionnaire (LEAF-Q) and Female Athlete Screening Tool (FAST) questionnaire was conducted on female participants in order to determine the risk. In addition, seven questions pertaining to the triad were asked in order to determine the athlete's knowledge of the triad. Athletes were requested to complete the anonymous questionnaire after written informed consent was obtained while waiting in the event registration queues. Statistical analyses included Pearson product-moment correlations, chi-square tests and cross-tabulations to evaluate associations of interest. RESULTS Knowledge of the triad was poor with 92.5 % of participants having not heard of the triad before and most of those who had, gained their knowledge from school or university. Only three athletes were able to name all 3 components of the triad. Amenorrhoea was the most commonly recalled component while five participants were able to name the component of low bone mineral density. Of the 306 athletes included in the study, 44.1 % were found to be at risk for the female athlete triad. One-third of participants demonstrated disordered eating behaviours with nearly half reporting restrictive eating behaviours. There is a significant association between athletes at risk for the triad according to the LEAF-Q and those with disordered eating (χ2(1) = 8.411, p = 0.014) but no association (or interaction) between triad knowledge and category (at risk/not at risk) of LEAF-Q score (χ2(1) = 0.004, p = 0.949). More athletes in the groups with clinical and sub-clinical eating disorders are at risk for the triad than expected under the null hypothesis for no association. CONCLUSIONS Only 7.5 % of the female Comrades Marathon runners knew about the triad despite 44.1 % being at a high risk for the triad. Therefore, education and regular screening programmes targeting these athletes are overdue. Postmenopausal athletes are at particularly high risk for large losses in bone mass if they experience chronic energy deficiency and hence require special focus.
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Affiliation(s)
- Lindy-Lee Folscher
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Hatfield, Pretoria, 0002 South Africa
| | - Catharina C Grant
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Hatfield, Pretoria, 0002 South Africa
| | - Lizelle Fletcher
- Department of Statistics, University of Pretoria, Hatfield, Pretoria, 0002 South Africa
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Kluitenberg B, van Middelkoop M, Diercks R, van der Worp H. What are the Differences in Injury Proportions Between Different Populations of Runners? A Systematic Review and Meta-Analysis. Sports Med 2015; 45:1143-61. [PMID: 25851584 PMCID: PMC4513221 DOI: 10.1007/s40279-015-0331-x] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many runners suffer from injuries. No information on high-risk populations is available so far though. OBJECTIVES The aims of this study were to systematically review injury proportions in different populations of runners and to compare injury locations between these populations. DATA SOURCES An electronic search with no date restrictions was conducted up to February 2014 in the PubMed, Embase, SPORTDiscus and Web of Science databases. The search was limited to original articles written in English. The reference lists of the included articles were checked for potentially relevant studies. STUDY ELIGIBILITY CRITERIA Studies were eligible when the proportion of running injuries was reported and the participants belonged to one or more homogeneous populations of runners that were clearly described. Study selection was conducted by two independent reviewers, and disagreements were resolved in a consensus meeting. STUDY APPRAISAL AND SYNTHESIS METHODS Details of the study design, population of runners, sample size, injury definition, method of injury assessment, number of injuries and injury locations were extracted from the articles. The risk of bias was assessed with a scale consisting of eight items, which was specifically developed for studies focusing on musculoskeletal complaints. RESULTS A total of 86 articles were included in this review. Where possible, injury proportions were pooled for each identified population of runners, using a random-effects model. Injury proportions were affected by injury definitions and durations of follow-up. Large differences between populations existed. The number of medical-attention injuries during an event was small for most populations of runners, except for ultra-marathon runners, in which the pooled estimate was 65.6%. Time-loss injury proportions between different populations of runners ranged from 3.2% in cross-country runners to 84.9% in novice runners. Overall, the proportions were highest among short-distance track runners and ultra-marathon runners. LIMITATIONS The results were pooled by stratification of studies according to the population, injury definition and follow-up/recall period; however, heterogeneity was high. CONCLUSIONS Large differences in injury proportions between different populations of runners existed. Injury proportions were affected by the duration of follow-up. A U-shaped pattern between the running distance and the time-loss injury proportion seemed to exist. Future prospective studies of injury surveillance are highly recommended to take running exposure and censoring into account.
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Affiliation(s)
- Bas Kluitenberg
- Center for Sports Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands,
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Barrack MT, Gibbs JC, De Souza MJ, Williams NI, Nichols JF, Rauh MJ, Nattiv A. Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women. Am J Sports Med 2014; 42:949-58. [PMID: 24567250 DOI: 10.1177/0363546513520295] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Identifying the risk factors associated with a bone stress injury (BSI), including stress reactions and stress fractures, may aid in targeting those at increased risk and in formulating prevention guidelines for exercising girls and women. PURPOSE To evaluate the effect of single or combined risk factors as defined by the female athlete triad-a syndrome involving 3 interrelated spectrums consisting of energy availability, menstrual function, and bone mass-with the incidence of BSIs in a multicenter prospective sample of 4 cohorts of physically active girls and women. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS At baseline, participants' (N = 259; mean age, 18.1 ± 0.3 years) anthropometric characteristics, eating attitudes and behaviors, menstrual function, sports participation or exercise activity, and pathological weight control behaviors were assessed. Dual-energy x-ray absorptiometry (DXA) measured the bone mass of the whole body, total hip, femoral neck, lumbar spine, and body composition. Participants were followed prospectively for the occurrence of injuries; those injuries confirmed by a physician were recorded. RESULTS Twenty-eight participants (10.8%) incurred a BSI. Forty-six percent of those who had ≥12 h/wk of purposeful exercise, a bone mineral density (BMD) Z score <-1.0, and who exhibited 3 to 4 of the following: BMI <21.0 kg/m2, oligo- or amenorrhea, elevated dietary restraint, and/or participation in a leanness sport exercise/activity at baseline, incurred a BSI during the prospective study period. Single factors significantly (P < .05) associated with the development of a BSI included ≥12 h/wk of purposeful exercise (14.7%), BMI <21.0 kg/m2 (15.3%), and low bone mass (BMD Z score <-1.0; 21.0%). The strongest 2- and 3-variable combined risk factors were low BMD (Z score <-1.0) + ≥12 h/wk of exercise, with 29.7% incurring a BSI (odds ratio [OR], 5.1; 95% CI, 2.2-12.1), and ≥12 h/wk of exercise + leanness sport/activity + dietary restraint, with 46.2% incurring a BSI (OR, 8.7; 95% CI, 2.7-28.3). CONCLUSION In the sample, which included female adolescents and young adults participating in competitive or recreational exercise activities, the risk of BSIs increased from approximately 15% to 20% for significant single risk factors to 30% to 50% for significant combined female athlete triad-related risk factor variables. These data support the notion that the cumulative risk for BSIs increases as the number of Triad-related risk factors accumulates.
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Affiliation(s)
- Michelle T Barrack
- Michelle T. Barrack, California State University, Northridge, 18111 Nordhoff Street, Northridge, CA 91330, USA.
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Duckham RL, Peirce N, Bailey CA, Summers G, Cameron N, Brooke-Wavell K. Bone geometry according to menstrual function in female endurance athletes. Calcif Tissue Int 2013; 92:444-50. [PMID: 23361333 DOI: 10.1007/s00223-013-9700-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
Abstract
Athletes have higher bone mineral density (BMD) relative to nonathletes. In amenorrheic athletes BMD may be compromised by estrogen deficiency, but it is unknown whether this is accompanied by structural differences. We compared femoral neck bone geometry and density of a-/oligomenorrheic athletes (AAs), eumenorrheic athletes (EAs), and eumenorrheic controls (ECs). We recruited 156 women: (68 endurance athletes and 88 controls). Femoral neck BMD, section modulus (Z), and width were measured using dual-energy X-ray absorptiometry. Menstrual function was assessed by questionnaire and classified as EA (≥10 periods/year) or AA (≤9 periods/year): 24 athletes were AA and 44 EA. Femoral neck BMD was significantly higher in EA than AA (8 %, difference) and EC (11 % difference): mean [SE] 1.118 [0.015], 1.023 [0.020] and 0.999 [0.014] g cm(-2), respectively; p < 0.001. Z was significantly higher in EA than EC (11 % difference): EA 667 [19], AA 625 [21], and EC 592 [10] cm(3); p < 0.001. Femoral neck width did not differ between groups. All differences persisted after adjustment for height, age, and body mass. The higher femoral neck Z and BMD in athletes, despite similar width, may indicate that exercise-related bone gains are endosteal rather than periosteal. Athletes with amenorrhea had smaller increments in bone mass rather than structural adaptation. The maintained femoral neck width in controls may be an adaptive mechanism to conserve bone strength in bending despite inactivity-related bone decrement.
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Affiliation(s)
- R L Duckham
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.
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Dadgostar H, Razi M, Aleyasin A, Alenabi T, Dahaghin S. The relation between athletic sports and prevalence of amenorrhea and oligomenorrhea in Iranian female athletes. BMC Sports Sci Med Rehabil 2009; 1:16. [PMID: 19642982 PMCID: PMC2732598 DOI: 10.1186/1758-2555-1-16] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Accepted: 07/30/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND In 1992, the concept of female athlete triad was introduced to describe the interrelated problems of amenorrhea, eating disorders and osteoporosis seen in female athletes. To gain a clearer picture of amenorrhea/oligomenorrhea in Iran, one of the main components of the female athlete triad, we therefore established this study on the prevalence of amenorrhea/oligomenorrhea in elite Iranian female athletes, also evaluating the risk factors of these disorders in the same population. METHODS This study performed as a cross-sectional study. All elite Iranian female athletes of 34 sports federation, including female athletes in national teams and medalists of Tehran were invited to participate. A total of 788 (95% response rate) returned the questionnaires and were examined. Younger athletes under the age of menarche were excluded. Each athlete completed a self-administered questionnaire, which covered the following questions about participant's demographic information, athletic history, history of injuries and menstrual pattern. In order to diagnose the causes of amenorrhea/Oligomenorrhea including polycystic ovary syndrome(PCOS), participants with amenorrhea/Oligomenorrhea underwent further investigation. They were evaluated by following Para clinic investigation, and an ultrasonographic study of ovary. RESULTS The age ranged from 13-37 (mean = 21.1, SD = 4.5). Seventy one (9.0%) individuals had amenorrhea/oligomenorrhea, among those, 11 (15.5%) had PCOS.There was also a positive association between amenorrhea/oligomenorrhea and the following: age under 20 OR; 2.67, 95%CI(1.47 - 4.85), weight class sports OR; 2.09, 95%CI(1.15 - 3.82), endurance sports OR; 2.89, 95%CI(1.22 - 6.84), late onset of menarche OR; 3.32 95%CI(1.04-10.51), and use of oral contraceptive pills OR; 6.17, 95%CI(3.00 - 12.69). Intensity of training sport or BMI were not risk factors. CONCLUSION These findings support the previous findings in the literature that the prevalence of amenorrhea/oligomenorrhea is high in athletes. Furthermore, we provided the first report on the prevalence of PCOS in female athletes with amenorrhea/oligomenorrhea. Athletes would be greatly benefited by greater general awareness about the complications of amenorrhea/oligomenorrhea.To increase awareness of exercise-associated menstrual cycle irregularities, it is necessary to design complete and comprehensive education programs for female athletes, their parents, their coaches, and the relevant authorities.
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Affiliation(s)
- Haleh Dadgostar
- Sport Medicine Department of Iran Medical University. Rassole Akram Hospital., Iran University, Tehran, Iran
| | - Mohammad Razi
- Orthopaedic and Sport Medicine Department of Iran Medical University. Rassole Akram Hospital., Iran University, Tehran, Iran
| | - Ashraf Aleyasin
- Gynaecologic and Obstetrics Department of Tehran Medical University. Shariati Hospital. Tehran University, Tehran, Iran
| | - Talia Alenabi
- Sport Medicine Federation, Islamic Republic of Iran. Tehran. Iran
| | - Saeideh Dahaghin
- Rheumatology Research Center, Shariati Hospital, Tehran University, Tehran, Iran
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Dadgostar H, Razi M, Aleyasin A, Alenabi T, Dahaghin S. The relation between athletic sports and prevalence of amenorrhea and oligomenorrhea in Iranian female athletes. Sports Med Arthrosc Rehabil Ther Technol 2009. [PMID: 19642982 DOI: 10.1186/1758–2555-1–16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In 1992, the concept of female athlete triad was introduced to describe the interrelated problems of amenorrhea, eating disorders and osteoporosis seen in female athletes. To gain a clearer picture of amenorrhea/oligomenorrhea in Iran, one of the main components of the female athlete triad, we therefore established this study on the prevalence of amenorrhea/oligomenorrhea in elite Iranian female athletes, also evaluating the risk factors of these disorders in the same population. METHODS This study performed as a cross-sectional study. All elite Iranian female athletes of 34 sports federation, including female athletes in national teams and medalists of Tehran were invited to participate. A total of 788 (95% response rate) returned the questionnaires and were examined. Younger athletes under the age of menarche were excluded. Each athlete completed a self-administered questionnaire, which covered the following questions about participant's demographic information, athletic history, history of injuries and menstrual pattern. In order to diagnose the causes of amenorrhea/Oligomenorrhea including polycystic ovary syndrome(PCOS), participants with amenorrhea/Oligomenorrhea underwent further investigation. They were evaluated by following Para clinic investigation, and an ultrasonographic study of ovary. RESULTS The age ranged from 13-37 (mean = 21.1, SD = 4.5). Seventy one (9.0%) individuals had amenorrhea/oligomenorrhea, among those, 11 (15.5%) had PCOS.There was also a positive association between amenorrhea/oligomenorrhea and the following: age under 20 OR; 2.67, 95%CI(1.47 - 4.85), weight class sports OR; 2.09, 95%CI(1.15 - 3.82), endurance sports OR; 2.89, 95%CI(1.22 - 6.84), late onset of menarche OR; 3.32 95%CI(1.04-10.51), and use of oral contraceptive pills OR; 6.17, 95%CI(3.00 - 12.69). Intensity of training sport or BMI were not risk factors. CONCLUSION These findings support the previous findings in the literature that the prevalence of amenorrhea/oligomenorrhea is high in athletes. Furthermore, we provided the first report on the prevalence of PCOS in female athletes with amenorrhea/oligomenorrhea. Athletes would be greatly benefited by greater general awareness about the complications of amenorrhea/oligomenorrhea.To increase awareness of exercise-associated menstrual cycle irregularities, it is necessary to design complete and comprehensive education programs for female athletes, their parents, their coaches, and the relevant authorities.
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Affiliation(s)
- Haleh Dadgostar
- Sport Medicine Department of Iran Medical University. Rassole Akram Hospital., Iran University, Tehran, Iran
| | - Mohammad Razi
- Orthopaedic and Sport Medicine Department of Iran Medical University. Rassole Akram Hospital., Iran University, Tehran, Iran
| | - Ashraf Aleyasin
- Gynaecologic and Obstetrics Department of Tehran Medical University. Shariati Hospital. Tehran University, Tehran, Iran
| | - Talia Alenabi
- Sport Medicine Federation, Islamic Republic of Iran. Tehran. Iran
| | - Saeideh Dahaghin
- Rheumatology Research Center, Shariati Hospital, Tehran University, Tehran, Iran
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Oyen J, Torstveit MK, Sundgot-Borgen J. Self-reported versus diagnosed stress fractures in norwegian female elite athletes. J Sports Sci Med 2009; 8:130-135. [PMID: 24150566 PMCID: PMC3737800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 02/09/2009] [Indexed: 06/02/2023]
Abstract
The aim of this study was to determine the prevalence of self- reported versus diagnosed stress fractures in female elite athletes and non-athletic controls. A random sample of Norwegian elite athletes from the national teams, aged 13-39 years (n = 186) and a random sample of non-athletic controls (n = 145) in the same age group participated in the study. The athletes represented a junior- or senior team, or a recruiting squad for one of these teams, in one of 46 different sports/events. A higher percentage of athletes self-reported stress fractures (14.0%) compared to those diagnosed with stress fractures (8.1%) (p < 0.001). Six controls self- reported stress fractures, but none of them were diagnosed with stress fractures. These results indicate that self-reporting of stress fractures has low validity. This finding has important implications for further research on stress fractures in athletes. Key pointsThis study is the first to compare self-reported and diagnosed stress fractures in the total population of elite athletes representing all kinds of sports.The results indicate that self-reporting of stress fractures has low validity in both athletes and non-athletic controls, and other measurement methods should be considered when evaluating possible stress fractures.Based on our results, stress fractures seem to be a sport-related injury.
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Affiliation(s)
- Jannike Oyen
- Department of Surgical Sciences, Faculty of Medicine and Dentistry, University of Bergen , Bergen, Norway
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