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Sharples A, Buchanan TD, Gough L, Black AD, Black KE. Risk of low energy availability, eating disorders and food insecurity amongst development female rugby league players. J Sports Med Phys Fitness 2024; 64:822-830. [PMID: 38470016 DOI: 10.23736/s0022-4707.24.15600-9] [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: 03/13/2024]
Abstract
BACKGROUND There have been several published studies on the prevalence of low energy availability (LEA) risk amongst North American and European endurance athletes. Yet the prevalence and risk factors amongst rugby league players are less well understood. This study assessed the prevalence of low energy availability risk, eating disorder risk, and food security amongst players from a female National Rugby League squad in Australia. METHODS Players from one Australian professional rugby league club volunteered to participate in the study. An online questionnaire was conducted to determine the prevalence of low energy availability (Low Energy Availability in Females Questionnaire [LEAF-Q]), eating disorder risk (Eating Disorders Inventory [EDI-3]), and food security. RESULTS Differences between those "at risk" and "not at risk" based on their total LEAF-Q score were determined. Of the 28 players, 64% (N.=18) were at risk of LEA. Raw scores for the EDI-3 subscales, body dissatisfaction (P=0.043), bulimia (P=0.002), composite score (P=0.038), were significantly higher for those at risk and not at risk of LEA. Forty percent of players had some level of food insecurity. CONCLUSIONS The results suggest LEA risk is similar to other populations and those at risk of LEA are more likely to have an elevated clinical risk of eating disorders. Food security is also an issue in this population and could contribute to LEA risk for some. Future research is needed amongst team sports athletes to understand interplay between eating disorder risk and food insecurity with LEA risk.
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Affiliation(s)
- Alice Sharples
- School of Sport, Exercise and Rehabilitation, Faculty of Health, University of Technology Sydney, Ultimo, Australia
- South Sydney Football Club, Sydney, Australia
- Human Performance Research Center, University of Technology Sydney, Ultimo, Australia
| | | | - Liam Gough
- South Sydney Football Club, Sydney, Australia
| | | | - Katherine E Black
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand -
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Modena A, Casiraghi MC, Erba D. Dietary intake and adherence to the Mediterranean diet in semi-professional female soccer players: a cross-sectional study. Front Nutr 2024; 11:1378365. [PMID: 38706566 PMCID: PMC11066240 DOI: 10.3389/fnut.2024.1378365] [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: 01/29/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Background Adequate energy and nutrient intakes in athletes contribute to optimal performance and recovery, decrease the risk of injury, and help preserve athletes' health. The Mediterranean diet (MD) is considered suitable for covering the nutritional needs of athletes, while contributing to improve eating habits. The aim of the present study was to investigate the energy and nutrient intakes of semi-professional female soccer players and their adherence to the MD, during the competitive season. Methods A cross-sectional observational study was conducted on twenty-three female soccer players, who were invited to fill in a 3-day food diary twice, one month apart, to assess their energy and nutrient intakes and a validated questionnaire (MEDI-LITE) to evaluate their adherence to MD. Exercise energy expenditure during three training and match-play days was monitored by GPS. Results On average, the participants consumed 1,981 kcal/day, with 44% of their energy deriving from carbohydrates, 21% from protein, and 34% from fat; the mean MD adherence score was 10.1 ± 1.8, corresponding to a good MD adherence. A substantial percentage of athletes were at risk of insufficient nutrient intakes for vitamin D (100%), iodine (87%), potassium (87%), vitamin E (39%), iron and zinc (17 and 30%, respectively). Conclusion The evaluation of the dietary intake in female soccer players showed energy deficiency in relation to training level, mainly due to the insufficient intake of carbohydrates, and micronutrient deficiencies. The technical staff should promote adequate consumption of starchy foods in female athletes and emphasize the importance of a proper distribution of energy intake among different eating occasions, including snacks. Periodic monitoring of the nutritional status of micronutrients (vitamin D and some minerals) could help reduce deficiency risk. Over all, nutrition education to improve eating habits of athletes seems worthy of attention, in order to preserve athletes' health and performance.
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Song H, Li Y, Zhang Z, Liu T. Exploring the relationship among soccer-related knowledge, attitude, practice, and self-health in Chinese campus soccer education. iScience 2024; 27:109409. [PMID: 38577100 PMCID: PMC10992701 DOI: 10.1016/j.isci.2024.109409] [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: 08/17/2023] [Revised: 01/29/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
China has promoted campus soccer for over a decade due to its potential health benefits. The study aimed to explore soccer knowledge (SK), soccer attitude (SA), soccer practice (SP), and health status among Chinese freshmen and sophomore undergraduates who had received campus soccer education. Of the 7419 participants, 1,069 were valid and included in the analysis. Structural equation modeling (SEM) results indicated SK is positively associated with SA (p < 0.001), but negatively with SP (p < 0.01). SA was positively linked to SP (p < 0.001). SK indirectly affected SP through SA (Z = 13.677). Random forest-tree-structured Parzen estimators (RF-TPE) with SHAP indicated SP holds primary importance with a strong negative impact on health. Additionally, differences in rankings for SK, SA, and SP were observed among gender and urban-rural groups. These results reveal current campus soccer education is suboptimal to health promotion.
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Affiliation(s)
- Honglin Song
- College of Physical Education and Sports Science, Beijing Normal University, Beijing 100875, China
| | - Yutao Li
- College of Physical Education and Sports Science, Beijing Normal University, Beijing 100875, China
| | - Zhenhang Zhang
- College of Physical Education and Sports Science, Beijing Normal University, Beijing 100875, China
| | - Tianbiao Liu
- College of Physical Education and Sports Science, Beijing Normal University, Beijing 100875, China
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Allen N, Kelly S, Lanfear M, Reynolds A, Clarke R, Mountjoy ML, Wyon M, Wolman R. Relative energy deficiency in dance (RED-D): a consensus method approach to REDs in dance. BMJ Open Sport Exerc Med 2024; 10:e001858. [PMID: 38463191 PMCID: PMC10921540 DOI: 10.1136/bmjsem-2023-001858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/12/2024] Open
Abstract
Relative energy deficiency in sport (REDs) is a potentially severe, challenging, broad-spectrum syndrome with potential negative health and performance outcomes. The numerous research publications and International Olympic Committee consensus statements relating to REDs testify to the challenges faced in early identification or screening, diagnosis and management. Like sport, dance, in its simplest form, can be identified as an activity resulting in physiological energy demands and, as such, requires appropriate energy availability concerning energy expenditures. However, the specificity of physiological and psychological demands in dance must be considered when considering REDs. An environment where physical activity can exceed 30 hours per week and where culture may instil a value that thinness is required puts dancers at increased risk for REDs. The purpose of this study was to provide dance-specific guidance dance on this complex condition. An RAND/UCLA Delphi Panel method with nominal group technique was used to review the literature from REDs to evaluate how it may relate to dance. In addition to the EP, which was assembled from a multidisciplinary background with expertise in REDs and multiple genres of dance, six focus groups were commissioned. Four of the focus groups were drawn from the EP members and two additional focus groups formed by dancers and artistic leaders. These panels were used to guide the development of a RED-D diagnosis pathway, management plan and risk stratification and return to dance pathway. The dance-specific pathways are designed to be a practical tool for guiding and supporting clinicians managing RED-D. Furthermore, this paper represents an important focus of this area in dance and serves to stimulate discussion and further research within the sector.
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Affiliation(s)
- Nick Allen
- Medical, Birmingham Royal Ballet, Birmingham, UK
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- National Institute of Dance Medicine and Science, Birmingham, UK
| | - Shane Kelly
- National Institute of Dance Medicine and Science, Birmingham, UK
- Ballet Healthcare, Royal Ballet Company, London, UK
| | | | | | | | | | - Matthew Wyon
- National Institute of Dance Medicine and Science, Birmingham, UK
- Sport and Physical Activity Research Centre, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK
| | - Roger Wolman
- National Institute of Dance Medicine and Science, Birmingham, UK
- University of Wolverhampton, Wolverhampton, UK
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5
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O'Donnell J, White C, Dobbin N. Perspectives on relative energy deficiency in sport (RED-S): A qualitative case study of athletes, coaches and medical professionals from a super league netball club. PLoS One 2023; 18:e0285040. [PMID: 37134124 PMCID: PMC10155971 DOI: 10.1371/journal.pone.0285040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Research into relative energy deficiency in sport (RED-S) has increased substantially over recent years given the impact on athletes' health and performance. Most studies have considered sports that place emphasis on the aesthetics, endurance, or weight-restriction. Fewer studies exist in team sports. Netball is a team sport yet to be explored despite players potentially being at risk of RED-S given the high training volumes, sporting culture, internal and external pressures, and small network of coaches and medical professionals. A qualitative case study was used to explore the perspective of athletes, coaches, and medical professionals on RED-S. METHODS Semi-structured interviews were conducted with 13 players, 4 coaches and 4 medical professionals affiliated to a Super League club. Interviews were recorded and transcribed verbatim. The data was analysed using thematic analysis. RESULTS Five main themes were identified in this study. Awareness of RED-S amongst athletes and coaches was generally inadequate whereas medical professionals had some awareness of RED-S. Some athletes used contraception to reduce discomfort/pain during menstruation whilst others expressed concerns around long-term contraceptive use and previous menstrual cycle disturbance. Sporting demands, individual and contextual factors, and a preoccupation with body image were associated with nutritional restriction, whilst appearance was a source of internal and external pressure. External pressures also extended to coaches, assessments/feedback, social media, and commentary. Strategies suggested to reduce the risk of RED-S included "hard hitting cases", multidisciplinary team involvement, and support from the governing body. CONCLUSION The findings of this study provide insight into factors potentially associated with the risk of RED-S from an athletes, coaches, and medical professional perspective. This insight can be used to increase overall awareness of RED-S in key stakeholders as well as improve the recognition for the pressures netball athletes face that might alter the level of risk.
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Affiliation(s)
- Justine O'Donnell
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Chris White
- Department of Health and Well-being, Wrexham Glyndwr University, Wrexham, United Kingdom
| | - Nick Dobbin
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
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6
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Prestemon CE, Grummon AH, Rummo PE, Taillie LS. Differences in Dietary Quality by Sexual Orientation and Sex in the United States: NHANES 2011-2016. J Acad Nutr Diet 2022; 122:918-931.e7. [PMID: 34896299 PMCID: PMC9038656 DOI: 10.1016/j.jand.2021.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 11/10/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are persistent disparities in weight- and diet-related diseases by sexual orientation. Lesbian and bisexual females have a higher risk of obesity and cardiovascular disease compared with heterosexual females. Gay and bisexual males have a higher risk of diabetes and cardiovascular disease compared with heterosexual males. However, it remains unknown how sexual orientation groups differ in their dietary quality. OBJECTIVE This study aimed to determine whether dietary quality differs by sexual orientation and sex among US adults. DESIGN This was a cross-sectional study of 24-hour dietary recall data from a nationally representative sample of adults aged 20 through 65 years participating in the 2011-2016 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING Study participants were adults (n = 8,851) with complete information on dietary intake, sexual orientation, and sex. MAIN OUTCOME MEASURES The main outcome measures were daily energy intake from 20 specific food and beverage groups and Healthy Eating Index-2015 (HEI-2015) scores for sexual orientation groups (heterosexual vs gay/lesbian/bisexual). STATISTICAL ANALYSES PERFORMED Ordinary least squares regressions were used to calculate adjusted means for each food and beverage group and HEI-2015, stratified by sex and controlling for covariates (eg, age and race/ethnicity) and survey cycles (2011-2012, 2013-2014, and 2015-2016). RESULTS Among males, red and processed meat/poultry/seafood (P = .01) and sandwiches (P = .02) were smaller contributors to energy intake for gay/bisexual males compared with heterosexual males. Among females, cereals (P =.04) and mixed dishes (P = .02) were smaller contributors to energy intake for lesbian/bisexual females compared with heterosexual females. Gay/bisexual males had significantly higher total HEI-2015 scores than heterosexual males (mean ± standard deviation 53.40 ± 1.36 vs 49.29 ± 0.32, difference = 4.14; P = .004). Lesbian/bisexual females did not differ in total or component HEI-2015 scores from heterosexual females. CONCLUSIONS Although gay/lesbian/bisexual groups were similar for a variety of dietary outcomes compared with heterosexual groups, gay and bisexual men displayed healthier dietary quality for processed meat (by consuming smaller amounts) and overall dietary quality (according to HEI-2015) compared with heterosexual males.
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Affiliation(s)
- Carmen E Prestemon
- Carolina Population Center, University of North Carolina, Chapel Hill, NC
| | - Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Pasquale E Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
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Impact of the Menstrual Cycle Phases on the Movement Patterns of Sub-Elite Women Soccer Players during Competitive Matches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084465. [PMID: 35457332 PMCID: PMC9025339 DOI: 10.3390/ijerph19084465] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 12/04/2022]
Abstract
The purpose of this study was to evaluate the influence of the menstrual cycle phases on the movement patterns of sub-elite women soccer players during competitive matches over three consecutive seasons. Individual movement data were analyzed and compared in eight players from the second French League at the early follicular (EF), late follicular (LF) and mid-luteal (ML) phases of their menstrual cycle, determined by the calendar method. The movement patterns, expressed as meters per minute, were recorded during competitive matches using devices placed on the player’s ankle. Our results showed significantly lower distances covered at moderate and high velocity in the EF phase than in the LF and ML phases (Cohen’s d effect size = 1.03 and 0.79, respectively). The total distance covered during matches and the number of sprints also were reduced during EF compared with LF (d = 0.78 and 0.7, respectively). Overall, the total distance and distance covered at low velocity were significantly lower during the second half-time of the matches (d = 1.51), but no menstrual cycle phase × game period interaction was noted. In conclusion, our study suggests that EF may impact the movement pattern of sub-elite women soccer players during competitive matches, without any modulation of this effect by the playing time. Despite the low sample size, these results can be useful for coaches and support staff to modulate training loads and player rotation during soccer games.
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8
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Julian R, Skorski S, Hecksteden A, Pfeifer C, Bradley PS, Schulze E, Meyer T. Menstrual cycle phase and elite female soccer match-play: influence on various physical performance outputs. SCI MED FOOTBALL 2022; 5:97-104. [PMID: 35077332 DOI: 10.1080/24733938.2020.1802057] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The aim of the study was to investigate whether menstrual cycle phases influence the physical performance during soccer match-play. METHODS Fifteen elite female soccer players, with physiologically normal menstrual cycles, competed in matches over a four-month period. Physical performance was assessed via GPS and expressed as meters per minute, and separated into four individualised thresholds (low, high, very high and sprinting). Seventy-six complete individual match observations, 36 from the follicular and 40 from the luteal phase were recorded. The differences in physical match performance parameters between the cycle phases were evaluated using a mixed linear model. RESULTS The results of the current study indicate that very high-intensity running distance was significantly greater during the luteal phase compared to the follicular phase (5.90 ± 2.16 m.min-1 vs. 6.64 ± 2.72 m.min-1; p = 0.02). However, this finding was accompanied by large variations across matches (CV = 39.5%). CONCLUSIONS Overall, the results suggest that the menstrual cycle phase does not influence match physical performance of female soccer players to a significant degree. Therefore, at present, interventions or other methods of coping with menstrual cycle phase do not seem necessary on a group/team level to maximise competitive physical performance.
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Affiliation(s)
- Ross Julian
- Institute of Sport and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Sabrina Skorski
- Institute of Sport and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Anne Hecksteden
- Institute of Sport and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Christina Pfeifer
- Institute of Sport and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Paul S Bradley
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Emiel Schulze
- Institute of Sport and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Tim Meyer
- Institute of Sport and Preventive Medicine, Saarland University, Saarbrücken, Germany
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9
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Tong X, Turunen MJ, Burton IS, Kröger H. Generalized Uncoupled Bone Remodeling Associated With Delayed Healing of Fatigue Fractures. JBMR Plus 2022; 6:e10598. [PMID: 35309868 PMCID: PMC8914151 DOI: 10.1002/jbm4.10598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 11/09/2022] Open
Abstract
Fatigue fractures in bones are common injuries with load‐bearing activities, during which the remodeling aimed at removing microdamage has been suggested to play a role in increasing related fracture risk. Much attention has been given to the uncoupling between osteoclastic bone resorption and osteoblastic osteogenesis in fatigue fracture cases; however, the underlying pathophysiologic mechanisms of impaired fracture healing are yet unknown. Here we report multiple fatigue fractures in a physically active woman receiving contraceptive pills for years. Her fracture healing was remarkably slow, although she has been otherwise healthy. The patient underwent bone biopsy of the iliac crest that showed remarkable peritrabecular fibrosis with increased osteoclastic bone resorption combined with relatively low bone formation. Analysis of bone biochemical composition revealed a more complex picture: First, notable declines in bone mineral content–based parameters indicating abnormal mineralization were evident in both cancellous and cortical bone. Second, there was elevation in mineral crystal size, perfection, and collagen maturity in her bone tissues from different anatomical sites. To our knowledge, this is the first report showing generalized uncoupling in bone remodeling, increased peritrabecular fibrosis, and bone compositional changes associated with delayed healing of fatigue fractures. These results may explain delayed healing of fatigue and stress fractures. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Xiaoyu Tong
- Kuopio Musculoskeletal Research Unit (KMRU), Clinical Research Centre, Institute of Clinical Medicine, University of Eastern Finland Kuopio Finland
| | - Mikael J Turunen
- Department of Applied Physics University of Eastern Finland Kuopio Finland
| | - Inari S Burton
- Kuopio Musculoskeletal Research Unit (KMRU), Clinical Research Centre, Institute of Clinical Medicine, University of Eastern Finland Kuopio Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Clinical Research Centre, Institute of Clinical Medicine, University of Eastern Finland Kuopio Finland
- Department of Orthopaedics, Traumatology, and Hand Surgery Kuopio University Hospital Kuopio Finland
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10
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de Sousa MV, Lundsgaard AM, Christensen PM, Christensen L, Randers MB, Mohr M, Nybo L, Kiens B, Fritzen AM. Nutritional optimization for female elite football players-topical review. Scand J Med Sci Sports 2021; 32 Suppl 1:81-104. [PMID: 34865242 DOI: 10.1111/sms.14102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/13/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
Women's football is an intermittent sport characterized by frequent intense actions throughout the match. The high number of matches with limited recovery time played across a long competitive season underlines the importance of nutritional strategies to meet these large physical demands. In order to maximize sport performance and maintain good health, energy intake must be optimal. However, a considerable proportion of female elite football players does not have sufficient energy intake to match the energy expenditure, resulting in low energy availability that might have detrimental physiologic consequences and impair performance. Carbohydrates appear to be the primary fuel covering the total energy supply during match-play, and female elite football players should aim to consume sufficient carbohydrates to meet the requirements of their training program and to optimize the replenishment of muscle glycogen stores between training bouts and matches. However, several macro- and micronutrients are important for ensuring sufficient energy and nutrients for performance optimization and for overall health status in female elite football players. The inadequacy of macro-and micronutrients in the diet of these athletes may impair performance and training adaptations, and increase the risk of health disorders, compromising the player's professional career. In this topical review, we present knowledge and relevant nutritional recommendations for elite female football players for the benefit of sports nutritionists, dietitians, sports scientists, healthcare specialists, and applied researchers. We focus on dietary intake and cover the most pertinent topics in sports nutrition for the relevant physical demands in female elite football players as follows: energy intake, macronutrient and micronutrient requirements and optimal composition of the everyday diet, nutritional and hydration strategies to optimize performance and recovery, potential ergogenic effects of authorized relevant supplements, and future research considerations.
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Affiliation(s)
- Maysa V de Sousa
- Laboratory of Medical Investigation, LIM-18, Endocrinology Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Anne-Marie Lundsgaard
- Department of Nutrition, Exercise and Sports, Section of Molecular Physiology, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | | | - Lars Christensen
- Department of Nutrition, Exercise and Sports, Section of Obesity Research, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Morten B Randers
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark.,School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Magni Mohr
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark.,Centre of Health Science, Faculty of Health, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Lars Nybo
- Department of Nutrition, Exercise and Sports, Section of Integrative Physiology, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Bente Kiens
- Department of Nutrition, Exercise and Sports, Section of Molecular Physiology, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Andreas M Fritzen
- Department of Nutrition, Exercise and Sports, Section of Molecular Physiology, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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11
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Sharps FRJ, Wilson LJ, Graham CAM, Curtis C. Prevalence of disordered eating, eating disorders and risk of low energy availability in professional, competitive and recreational female athletes based in the United Kingdom. Eur J Sport Sci 2021; 22:1445-1451. [PMID: 34121611 DOI: 10.1080/17461391.2021.1943712] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Eating disorders (ED), disordered eating (DE) and low energy availability (LEA) can be detrimental to health and performance. Previous studies have independently investigated the prevalence of ED, DE or LEA; however, few combined methods have identified risk within female athletes. The aim of this study was to identify the prevalence of ED, DE and LEA in UK-based female athletes and investigate whether associations exist between age, competition level and primary sport. The Female Athlete Screening Tool (FAST) and Low Energy Availability in Females Questionnaire (LEAF-Q) were used in a cross-sectional study design. A total of 112 responses eligible for analysis were received. A total of 16%, 44% and 53% of female athletes were at risk of ED (FAST: >94), DE and LEA, respectively. Competition level (recreational, competitive or professional athletes; fishers, p ≤ 0.05) influenced and was a predictor of FAST (R2 = 0.076, F(1,110) = 10.067, p ≤ 0.05, variance inflation value; VIF = 1.0) whereas age influenced (age: H(2) = 13.128, p ≤ 0.05), and was a predictor (R2 = 0.144, F(2,109) = 9.170, p ≤ 0.05, VIF = 1.0) of LEAF-Q. A positive correlation was observed between FAST and LEAF-Q scores (R = 0.496, p ≤ 0.05). Age and competition level may be predicting risk factors of ED/DE and LEA within female athletes; however, further research is required to support the findings of this present study.
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Affiliation(s)
| | | | - Catherine Anna-Marie Graham
- Oxford Brookes Centre for Nutrition and Health, Faculty of Health and Life Sciences, Department of Sport, Health and Social Work, Oxford Brookes University, Oxford, UK
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12
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Aalberg K, Stavem K, Norheim F, Russell MB, Chaibi A. Effect of oral and transdermal oestrogen therapy on bone mineral density in functional hypothalamic amenorrhoea: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2021; 7:e001112. [PMID: 34306727 PMCID: PMC8264872 DOI: 10.1136/bmjsem-2021-001112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/03/2022] Open
Abstract
Background Female athletes might develop reduced bone mineral density (BMD) and amenorrhoea due to low energy intake. Objective To systematically review the literature of randomised controlled trials (RCTs) assessing the effect of oestrogen oral contraceptives (OCP), conjugated oestrogens (CE) and transdermal estradiol (TE) on BMD in premenopausal women with functional hypothalamic amenorrhoea (FHA) due to weight loss, vigorous exercise and/or stress. Methods A comprehensive literature search in PubMed, MEDLINE, Cochrane Library, Ovid and CINAHL from inception to 1 October 2020. Data extraction and synthesis Two authors independently extracted data. When possible, the data were pooled in a random-effects meta-analysis. Main outcomes Difference in BMD (g/cm2) at the lumbar spine. Results Nine RCTs comprising 770 participants met the inclusion criteria; five studies applied OCP, two CE and two TE. Four RCTs (two OCP, two TE) found an increased BMD in premenopausal women with FHA, and five (three OCP, two CE) found a decreased BMD compared with controls. A meta-analysis showed no difference in BMD between the treatment and control groups, (standardised mean difference (SMD) 0.30, 95% CI -0.12 to 0.73). A secondary analysis for change scores from baseline to first assessment point, showed a similar overall result (SMD 0.17, 95% CI -0.16 to 0.51). No serious adverse events were reported. Conclusion The literature suggests that TE might increase lumbar BMD in premenopausal women with FHA, but pooled results revealed no effect of the intervention. The findings do not support oestrogen therapy to improve BMD in these patient groups.
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Affiliation(s)
| | - Knut Stavem
- Institute of Clinical Medicine, Akershus University Hospital, Lorenskog, Norway.,Department of Pulmonary Medicine, University of Oslo, Akershus University Hospital, Lorenskog, Norway
| | - Frode Norheim
- Department of Nutrition, University of Oslo, Institute of Basic Medical Sciences, Oslo, Norway
| | - Michael Bjørn Russell
- Institute of Clinical Medicine, Akershus University Hospital, Lorenskog, Norway.,Head and Neck Research Group, Division for Research and Innovation, Akershus University Hospital, Lorenskog, Norway
| | - Aleksander Chaibi
- Head and Neck Research Group, Division for Research and Innovation, Akershus University Hospital, Lorenskog, Norway.,Department for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
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13
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Randell RK, Clifford T, Drust B, Moss SL, Unnithan VB, De Ste Croix MBA, Datson N, Martin D, Mayho H, Carter JM, Rollo I. Physiological Characteristics of Female Soccer Players and Health and Performance Considerations: A Narrative Review. Sports Med 2021; 51:1377-1399. [PMID: 33844195 PMCID: PMC8222040 DOI: 10.1007/s40279-021-01458-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/18/2022]
Abstract
Female soccer has seen a substantial rise in participation, as well as increased financial support from governing bodies over the last decade. Thus, there is an onus on researchers and medical departments to develop a better understanding of the physical characteristics and demands, and the health and performance needs of female soccer players. In this review, we discuss the current research, as well as the knowledge gaps, of six major topics: physical demands, talent identification, body composition, injury risk and prevention, health and nutrition. Data on female talent identification are scarce, and future studies need to elucidate the influence of relative age and maturation selection across age groups. Regarding the physical demands, more research is needed on the pattern of high-intensity sprinting during matches and the contribution of soccer-specific movements. Injuries are not uncommon in female soccer players, but targeting intrinsically modifiable factors with injury prevention programmes can reduce injury rates. The anthropometric and physical characteristics of female players are heterogeneous and setting specific targets should be discouraged in youth and sub-elite players. Menstrual cycle phase may influence performance and injury risk; however, there are few studies in soccer players. Nutrition plays a critical role in health and performance and ensuring adequate energy intake remains a priority. Despite recent progress, there is considerably less research in female than male soccer players. Many gaps in our understanding of how best to develop and manage the health and performance of female soccer players remain.
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Affiliation(s)
- Rebecca K Randell
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK.
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - Thomas Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Barry Drust
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Samantha L Moss
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK
- Department of Sport and Exercise Sciences, University of Chester, Chester, UK
| | - Viswanath B Unnithan
- Institute of Clinical Exercise and Health Science, Division of Sport and Exercise, School of Health and Life Sciences, University of the West of Scotland, Hamilton, Scotland, UK
| | | | - Naomi Datson
- Institute of Sport, University of Chichester, Chichester, UK
| | - Daniel Martin
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
| | - Hannah Mayho
- Sports Science Department, Manchester City Football Club, Manchester, UK
| | - James M Carter
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK
| | - Ian Rollo
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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14
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Parker LJ, Elliott-Sale KJ, Hannon MP, Morton JP, Close GL. An audit of hormonal contraceptive use in Women’s Super League soccer players; implications on symptomology. SCI MED FOOTBALL 2021; 6:153-158. [DOI: 10.1080/24733938.2021.1921248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lloyd J. Parker
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Everton Football Club, USM Finch Farm, Halewood Liverpool, Liverpool, UK
| | - Kirsty J. Elliott-Sale
- Sport Health and Performance Enhancement Research Centre, Nottingham Trent University, Nottingham, UK
| | - Marcus P. Hannon
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - James P. Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Graeme L. Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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15
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Abbott W, Brett A, Brownlee TE, Hammond KM, Harper LD, Naughton RJ, Anderson L, Munson EH, Sharkey JV, Randell RK, Clifford T. The prevalence of disordered eating in elite male and female soccer players. Eat Weight Disord 2021; 26:491-498. [PMID: 32107745 PMCID: PMC7946675 DOI: 10.1007/s40519-020-00872-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/11/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To examine the prevalence of disordered eating (DE) in elite male and female soccer players and the influence of perfectionism. METHODS Using a cross-sectional design, elite male (n = 137) and female (n = 70) soccer players and non-athlete controls (n = 179) completed the clinical perfectionism questionnaire (CPQ-12) and the eating attitudes test (EAT-26) to assess perfectionism and DE risk, respectively. RESULTS Male soccer players had higher EAT-26 scores than controls (10.4 ± 9.9 vs. 6.8 ± 6.7; P = 0.001), but there were no differences in the prevalence of clinical levels of DE (EAT-26 score ≥ 20) (15 vs. 5%, respectively; X2 = 0.079) The proportion of females with DE risk was higher in controls [EAT-26: 13.9 ± 11.6 (25% of population)] than female players [EAT-26: 10.0 ± 9.0% (11% of population)] (X2 = 0.001). With linear regression, perfectionism explained 20% of the variation in DE risk in males (P = 0.001); in females, athletic status (player vs. control) and perfectionism were significant predictors of DE risk, explaining 21% of the variation (P = 0.001). Male reserve team players had higher EAT-26 (+ 3.5) and perfectionism (+ 2.7) scores than first-team players (P < 0.05). There were no differences in the prevalence of DE risk between the male and female soccer players (X2 = 0.595). CONCLUSIONS The prevalence of DE risk was not different in elite male and female soccer players; in fact, the prevalence was greatest in non-athlete female controls. Perfectionism is a significant predictor of DE risk in males and females. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Will Abbott
- Brighton and Hove Albion F.C, American Express Elite Performance Centre, Lancing, UK
| | - Adam Brett
- Brighton and Hove Albion F.C, American Express Elite Performance Centre, Lancing, UK
| | - Thomas E Brownlee
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Kelly M Hammond
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Liam D Harper
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Robert J Naughton
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Liam Anderson
- Crewe Alexandra Football Club, Alexandra Stadium, Gretsy Road, Crewe, Cheshire, UK
| | | | | | - Rebecca K Randell
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Tom Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
- Institute of Cellular Medicine, Newcastle University, Newcastle on Tyne, UK.
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16
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Martin D, Timmins K, Cowie C, Alty J, Mehta R, Tang A, Varley I. Injury Incidence Across the Menstrual Cycle in International Footballers. Front Sports Act Living 2021; 3:616999. [PMID: 33733235 PMCID: PMC7956981 DOI: 10.3389/fspor.2021.616999] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: This study aimed to assess how menstrual cycle phase and extended menstrual cycle length influence the incidence of injuries in international footballers. Methods: Over a 4-year period, injuries from England international footballers at training camps or matches were recorded, alongside self-reported information on menstrual cycle characteristics at the point of injury. Injuries in eumenorrheic players were categorized into early follicular, late follicular, or luteal phase. Frequencies were also compared between injuries recorded during the typical cycle and those that occurred after the cycle would be expected to have finished. Injury incidence rates (per 1,000 person days) and injury incidence rate ratios were calculated for each phase for all injuries and injuries stratified by type. Results: One hundred fifty-six injuries from 113 players were eligible for analysis. Injury incidence rates per 1,000 person-days were 31.9 in the follicular, 46.8 in the late follicular, and 35.4 in the luteal phase, resulting in injury incidence rate ratios of 1.47 (Late follicular:Follicular), 1.11 (Luteal:Follicular), and 0.76 (Luteal:Late follicular). Injury incident rate ratios showed that muscle and tendon injury rates were 88% greater in the late follicular phase compared to the follicular phase, with muscle rupture/tear/strain/cramps and tendon injuries/ruptures occurring over twice as often during the late follicular phase compared to other phases 20% of injuries were reported as occurring when athletes were “overdue” menses. Conclusion: Muscle and tendon injuries occurred almost twice as often in the late follicular phase compared to the early follicular or luteal phase. Injury risk may be elevated in typically eumenorrheic women in the days after their next menstruation was expected to start.
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Affiliation(s)
- Dan Martin
- School of Sport and Exercise Science, University of Lincoln, Lincoln, United Kingdom
| | - Kate Timmins
- School of Sport and Exercise Science, University of Lincoln, Lincoln, United Kingdom
| | | | - Jon Alty
- The Football Association, London, United Kingdom
| | - Ritan Mehta
- The Football Association, London, United Kingdom
| | - Alicia Tang
- The Football Association, London, United Kingdom
| | - Ian Varley
- Department of Sport and Exercise Science, Nottingham Trent University, Nottingham, United Kingdom
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17
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Collins J, Maughan RJ, Gleeson M, Bilsborough J, Jeukendrup A, Morton JP, Phillips SM, Armstrong L, Burke LM, Close GL, Duffield R, Larson-Meyer E, Louis J, Medina D, Meyer F, Rollo I, Sundgot-Borgen J, Wall BT, Boullosa B, Dupont G, Lizarraga A, Res P, Bizzini M, Castagna C, Cowie CM, D'Hooghe M, Geyer H, Meyer T, Papadimitriou N, Vouillamoz M, McCall A. UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research. Br J Sports Med 2020; 55:416. [PMID: 33097528 DOI: 10.1136/bjsports-2019-101961] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 01/09/2023]
Abstract
Football is a global game which is constantly evolving, showing substantial increases in physical and technical demands. Nutrition plays a valuable integrated role in optimising performance of elite players during training and match-play, and maintaining their overall health throughout the season. An evidence-based approach to nutrition emphasising, a 'food first' philosophy (ie, food over supplements), is fundamental to ensure effective player support. This requires relevant scientific evidence to be applied according to the constraints of what is practical and feasible in the football setting. The science underpinning sports nutrition is evolving fast, and practitioners must be alert to new developments. In response to these developments, the Union of European Football Associations (UEFA) has gathered experts in applied sports nutrition research as well as practitioners working with elite football clubs and national associations/federations to issue an expert statement on a range of topics relevant to elite football nutrition: (1) match day nutrition, (2) training day nutrition, (3) body composition, (4) stressful environments and travel, (5) cultural diversity and dietary considerations, (6) dietary supplements, (7) rehabilitation, (8) referees and (9) junior high-level players. The expert group provide a narrative synthesis of the scientific background relating to these topics based on their knowledge and experience of the scientific research literature, as well as practical experience of applying knowledge within an elite sports setting. Our intention is to provide readers with content to help drive their own practical recommendations. In addition, to provide guidance to applied researchers where to focus future efforts.
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Affiliation(s)
- James Collins
- Intra Performance Group, London, UK.,Performance and Research Team, Arsenal Football Club, London, UK
| | | | - Michael Gleeson
- School of Sports Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Johann Bilsborough
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia.,New England Patriots, Foxboro, MA, USA
| | - Asker Jeukendrup
- School of Sports Exercise and Health Sciences, Loughborough University, Loughborough, UK.,MySport Science, Birmingham, UK
| | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - S M Phillips
- Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Armstrong
- Human Performance Laboratory, University of Connecticut, Storrs, CT, USA
| | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Rob Duffield
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia.,Medical Department, Football Federation Australia, Sydney, New South Wales, Australia
| | - Enette Larson-Meyer
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Julien Louis
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Daniel Medina
- Athlete Care and Performance, Monumental Sports & Entertainment, Washington, DC, USA
| | - Flavia Meyer
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ian Rollo
- School of Sports Exercise and Health Sciences, Loughborough University, Loughborough, UK.,PepsiCo Life Sciences, Global R&D, Gatorade Sports Science Institute, Birmingham, UK
| | | | - Benjamin T Wall
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | | | - Gregory Dupont
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Peter Res
- Dutch Olympic Team, Amsterdam, Netherlands
| | - Mario Bizzini
- Research and Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
| | - Carlo Castagna
- University of Rome Tor Vergata, Rome, Italy.,Technical Department, Italian Football Federation (FIGC), Florence, Italy.,Italian Football Referees Association, Bologna, Italy
| | - Charlotte M Cowie
- Technical Directorate, Football Association, Burton upon Trent, UK.,Medical Committee, UEFA, Nyon, Switzerland
| | - Michel D'Hooghe
- Medical Committee, UEFA, Nyon, Switzerland.,Medical Centre of Excelence, Schulthess Clinic, Zurich, Switzerland
| | - Hans Geyer
- Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany
| | - Tim Meyer
- Medical Committee, UEFA, Nyon, Switzerland.,Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | | | | | - Alan McCall
- Performance and Research Team, Arsenal Football Club, London, UK .,Medical Department, Football Federation Australia, Sydney, New South Wales, Australia.,Sport, Exercise and Health Sciences, School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
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18
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Moss SL, Randell RK, Burgess D, Ridley S, ÓCairealláin C, Allison R, Rollo I. Assessment of energy availability and associated risk factors in professional female soccer players. Eur J Sport Sci 2020; 21:861-870. [PMID: 32633208 DOI: 10.1080/17461391.2020.1788647] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aimed to assess energy availability (EA), alongside possible risk factors of reduced or low EA of professional female soccer players during a competitive season. Thirteen players (age: 23.7 ± 3.4 y, stature: 1.69 ± 0.08 m, body mass: 63.7 ± 7.0 kg) engaged in a 5-day (two rest days, one light training, heavy training and match day) monitoring period. Energy intake (EI) and expenditure during exercise (EEE) were measured. EA was calculated and categorised as optimal, reduced or low (>45, 30-45, <30 kcal·kg FFM-1·day-1, respectively). Relationships between EA and bone mineral density, resting metabolic rate (RMR), plasma micronutrient status, biochemical markers and survey data were assessed. EA was optimal for 15%, reduced for 62% and low for 23% of players. Higher EA was observed on rest days compared to others (P<0.05). EA was higher for the light compared to the heavy training day (P<0.001). EEE differed significantly between days (P<0.05). EI (2124 ± 444 kcal), carbohydrate (3.31 ± 0.64 g·kg·day-1) and protein (1.83 ± 0.41 g·kg·day-1) intake remained similar (P>0.05). Survey data revealed 23% scored ≥8 on the Low Energy Availability in Females Questionnaire and met criteria for low RMR (ratio <0.90). Relationships between EA and risk factors were inconclusive. Most players displayed reduced EA and did not alter EI or carbohydrate intake according to training or match demands. Although cases of low EA were identified, further work is needed to investigate possible long-term effects and risk factors of low and reduced EA separately to inform player recommendations.
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Affiliation(s)
- Samantha L Moss
- Department of Sport and Exercise Sciences, University of Chester, Chester, UK.,Gatorade Sports Science Institute, R&D Life Sciences, PepsiCo, Leicestershire, UK
| | - Rebecca K Randell
- Gatorade Sports Science Institute, R&D Life Sciences, PepsiCo, Leicestershire, UK.,School of Sports, Exercise and Health Sciences, Loughborough University, UK
| | | | | | | | | | - Ian Rollo
- Gatorade Sports Science Institute, R&D Life Sciences, PepsiCo, Leicestershire, UK.,School of Sports, Exercise and Health Sciences, Loughborough University, UK
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19
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Kampouri D, Kotopoulea-Nikolaidi M, Daskou S, Giannopoulou I. Prevalence of disordered eating in elite female athletes in team sports in Greece. Eur J Sport Sci 2019; 19:1267-1275. [DOI: 10.1080/17461391.2019.1587520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dimitra Kampouri
- Department of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kotopoulea-Nikolaidi
- Department of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Daskou
- Nottingham Business School, Nottingham Trent University, Nottingham, UK
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20
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Young Female Football Players, Research and Intervention. Asian J Sports Med 2019. [DOI: 10.5812/asjsm.86287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Soccer helps build strong bones during growth: a systematic review and meta-analysis. Eur J Pediatr 2018; 177:295-310. [PMID: 29282554 DOI: 10.1007/s00431-017-3060-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 01/08/2023]
Abstract
UNLABELLED The aim of this study was to analyze the effects of soccer practice on bone in male and female children and adolescents. MEDLINE, PubMed, SPORTDiscus and Web of Science databases were searched for scientific articles published up to and including October 2016. Twenty-seven studies were included in this systematic review (13 in the meta-analysis). The meta-analysis was performed by using OpenMeta[Analyst] software. It is well documented that soccer practice during childhood provides positive effects on bone mineral content (BMC) and density (BMD) compared to sedentary behaviors and other sports, such as tennis, weightlifting, or swimming. Furthermore, soccer players present higher BMC and BMD in most weight-bearing sites such as the whole body, lumbar spine, hip, and legs. Moreover, bone differences were minimized between groups during prepuberty. Therefore, the maturity status should be considered when evaluating bone. According to meta-analysis results, soccer practice was positively associated with whole-body BMD either in males (mean difference 0.061; 95%CI, 0.042-0.079) or in females (mean difference 0.063; 95%CI, 0.026-0.099). CONCLUSION Soccer may be considered a sport that positively affects bone mass during growth. Pubertal soccer players presented increased bone mass compared to controls or other athletes; however, these bone differences are minimized during the prepubertal stage. What is known: • It has been described that childhood and adolescence are important periods for bone mass and structure. • Previous studies have demonstrated that soccer participation improves bone mass in male and female children and adolescents. What is new: • The differences between soccer players and controls are more marked during puberty than prepuberty. • Weight-bearing sites such as lumbar spine, hip, femoral neck, trochanter, intertrochanteric region and both legs are particularly sensitive to soccer actions.
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22
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Abstract
PURPOSE To investigate energy intake, energy expenditure, and the nutritional status of young female elite football players using 7-day food and activity records and blood parameters. METHODS A total of 56 female elite football players [14.8 (0.7) y] completed the requested food and activity protocols. Misreporting was assessed by the ratio of energy intake to energy expenditure. The food records were analyzed concerning energy and macronutrient and micronutrient intakes, and energy expenditure was calculated using predictive equations. Hematological data and 25-hydroxyvitamin D serum concentrations were determined. RESULTS Mean energy intake was 2262 (368) kcal/d [40.5 (7.0) kcal/kg/d] and estimated EE averaged 2403 (195) kcal/d. Fifty-three percent of the players exhibited an energy availability <30 kcal/kg lean body mass; 31% of the athletes consumed <5 g/kg carbohydrates and 34% consumed <1.2 g/kg proteins. A large proportion of players (%) had intakes below the recommended daily allowance of folate (75%), vitamin D (100%), iron (69%), and calcium (59%). Ferritin and 25-hydroxyvitamin D serum levels were below the recommendations of 59% and 38%, respectively. CONCLUSIONS A remarkable number of players failed to meet the energy balance and the recommended carbohydrate and protein intakes. Low iron and 25-hydroxyvitamin D serum levels were observed showing a suboptimal nutrition status of some young female football players. As a consequence, strategies have to be developed for a better information and application of sport nutrition practice among young female football players.
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23
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Saunier J, Chapurlat R. Stress fracture in athletes. Joint Bone Spine 2017; 85:307-310. [PMID: 28512006 DOI: 10.1016/j.jbspin.2017.04.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/24/2017] [Indexed: 12/20/2022]
Abstract
Stress fractures are widely encountered in sport medicine and rheumatology. Stress fractures result from abnormal and repetitive loading on normal bone that lead to microdamage and then fracture. They occur after sudden increase in physical activity. They appear mostly at lower limbs. Women are at higher risk than men. Patients complain of mechanical pain. Clinical findings include focused pain and sometimes swelling. No biological test is useful for diagnosis. Plain radiographs are normal in early stage disease. MRI is the gold standard to confirm stress fracture. Treatments of stress fracture always involve rest and analgesics. Non-steroidal anti-inflammatory should be use cautiously because they may inhibit callus formation. Extracorporeal shockwave may be a new approach for SF not healing with rest. Surgical treatment is often needed in high risk stress fracture of delayed healing, non-union or complete fracture.
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Affiliation(s)
- Jordane Saunier
- Service de rhumatologie, CHU Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - Roland Chapurlat
- Service de rhumatologie, CHU Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
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24
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25
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Wright H, Ford R, Botha C. A desire for weight loss in season increases disordered eating behaviour risk and energy deficiency in athletes. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2014.11734500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Shimasaki Y, Nagao M, Miyamori T, Aoba Y, Fukushi N, Saita Y, Ikeda H, Kim SG, Nozawa M, Kaneko K, Yoshimura M. Evaluating the Risk of a Fifth Metatarsal Stress Fracture by Measuring the Serum 25-Hydroxyvitamin D Levels. Foot Ankle Int 2016; 37:307-11. [PMID: 26596794 DOI: 10.1177/1071100715617042] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The fifth metatarsal bone is a common site of stress fractures in soccer athletes. Although several endocrine risk factors for stress fractures have been proposed, the endocrine risks for fifth metatarsal (5-MT) stress fractures have not been evaluated. METHODS To evaluate the endocrine risks of fifth metatarsal stress fractures, we conducted a cumulative case-control study. The present study included 37 athletes, of which 18 had a history of a zone 2 or zone 3 fifth metatarsal stress fracture and 19 controls. We analyzed serum 25-hydroxyvitamin D (25-OHD), serum parathyroid hormone (PTH), as well as biochemical markers of bone turnover by univariate or multivariate analyses. RESULTS Logistic regression analyses adjusted for multiple confounders revealed that insufficient serum 25-OHD levels less than 30 ng/mL (odds ratio [OR], 23.3), higher serum PTH levels (OR, 1.01), or higher serum bone-specific isoform of alkaline phosphatase levels (OR, 1.10) rather than serum tartrate-resistant acid phosphatase 5b were associated with statistically significantly increased odds of 5-MT stress fractures. A postestimation calculation demonstrated that 25-OHD levels of 10 and 20 ng/mL were associated with 5.1 and 2.9 times greater odds for 5-MT stress fractures, respectively. CONCLUSION 25-OHD insufficiency was associated with an increased incidence of 5-MT stress fractures. This insight may be useful for intervening to prevent 5-MT stress fractures. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Yu Shimasaki
- School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Masashi Nagao
- Department of Orthopedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takayuki Miyamori
- Department of Nursing and Rehabilitation Science, School of Physical Therapy at Odawara, International University of Health and Sports Science, Kanagawa, Japan
| | - Yukihiro Aoba
- School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Norifumi Fukushi
- Institute of Physical Education, Keio University, Kanagawa, Japan
| | - Yoshitomo Saita
- Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Hiroshi Ikeda
- Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Sung-Gon Kim
- Department of Orthopedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Masahiko Nozawa
- Department of Orthopedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Masafumi Yoshimura
- School of Health and Sports Science, Juntendo University, Chiba, Japan Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
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27
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Are Elite Female Soccer Athletes at Risk for Disordered Eating Attitudes, Menstrual Dysfunction, and Stress Fractures? PM R 2015; 8:208-13. [PMID: 26188245 DOI: 10.1016/j.pmrj.2015.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/30/2015] [Accepted: 07/03/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the prevalence of stress fractures, menstrual dysfunction and disordered eating attitudes in elite female soccer athletes. DESIGN Cross-sectional descriptive study. SETTING Female soccer athletes were recruited from a national level youth soccer club, an NCAA Division I university team, and a women's professional team. PARTICIPANTS Two hundred twenty female soccer athletes with a mean age of 16.4 ± 4 years and BMI of 20.8 ± 2 kg/m(2) completed the study, representing all athletes from the included teams. METHODS One-time surveys completed by the athletes. MAIN OUTCOME MEASUREMENTS Height and weight were recorded, and body mass index (BMI) was calculated for each athlete. Athletes reported age of menarche, history of missing 3 or more menses within a 12-month period and stress fracture. The Eating Attitudes Test (EAT-26) was used to assess the athlete's body perception and attitudes toward eating. RESULTS Of the 220 soccer athletes, 3 athletes (1.6%) had a low BMI for their age, and 19 (8.6%) reported stress fractures of the lower extremity. Among athletes who had reached menarche, the average onset was 13 + 1 year; menstrual dysfunction were present in 21 (19.3%). On the EAT-26, 1 player scored in the high risk range (>20) and 17 (7.7%) scored in the intermediate risk range (10-19) for eating disorders. Athletes with an EAT-26 score ≥ 10 points had a significantly higher prevalence of menstrual dysfunction in the past year compared to athletes with an EAT-26 score of less than 10 (P = .02). CONCLUSIONS Elite female soccer athletes are susceptible to stress fractures and menstrual dysfunction and have delayed onset of menarche despite normal BMI and appropriate body perception and attitudes towards eating. Further studies are needed to better understand stress fracture risk in female soccer athletes and in other team sports to determine how these findings relate to long-term bone health in this population.
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Kalnina L, Sauka M, Timpka T, Dahlström Ö, Nylander E, Selga G, Ligere R, Karklina H, Priedite IS, Larins V. Body fat in children and adolescents participating in organized sports: Descriptive epidemiological study of 6048 Latvian athletes. Scand J Public Health 2015; 43:615-22. [PMID: 25948090 DOI: 10.1177/1403494815581696] [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] [Accepted: 03/19/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pressure among young athletes to meet body composition goals may lead to poor nutrition and affect growth. AIMS To examine the proportion of body fat (%BF), measured by bioimpedance analysis, among Latvian children and adolescents participating in organized sports. METHODS Our study had a nationally representative sample of 6048 young athletes, aged 10-17 years. Their %BF was measured using a multifrequency, 8-pole, bioelectrical impedance leg-to-hand analyzer. RESULTS About 19.2% (CI 14.4-20.0) of boys and 15.1% (CI 14.0-16.3) of girls had a %BF value below the recommended levels. The %BF in young female athletes participating in aesthetic sports was lower than among their peers participating in other sports. Young male athletes participating in aesthetic sports had lower %BF levels at 10 and 12 years of age, compared with participants in weight-class sports; and lower levels of %BF from age 10-14 years, compared with participants in non-weight-sensitive sports. CONCLUSIONS Almost every fifth child and adolescent participating in organized sports displayed critically low body fat levels. Body fat needs to be assessed regularly in young athletes, to prevent negative consequences on health.
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Affiliation(s)
- Liga Kalnina
- State Sports Medicine Centre, Riga, Latvia Latvian University, Riga, Latvia
| | | | | | | | - Eva Nylander
- Department of Clinical Physiology, County Council of Östergötland, Linköping, Sweden
| | - Guntars Selga
- State Sports Medicine Centre, Riga, Latvia Riga Stradins University, Riga, Latvia
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Reed JL, De Souza MJ, Kindler JM, Williams NI. Nutritional practices associated with low energy availability in Division I female soccer players. J Sports Sci 2014; 32:1499-509. [DOI: 10.1080/02640414.2014.908321] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Melin A, Tornberg AB, Skouby S, Faber J, Ritz C, Sjödin A, Sundgot-Borgen J. The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. Br J Sports Med 2014; 48:540-5. [PMID: 24563388 DOI: 10.1136/bjsports-2013-093240] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Low energy availability (EA) in female athletes with or without an eating disorder (ED) increases the risk of oligomenorrhoea/functional hypothalamic amenorrhoea and impaired bone health, a syndrome called the female athlete triad (Triad). There are validated psychometric instruments developed to detect disordered eating behaviour (DE), but no validated screening tool to detect persistent low EA and Triad conditions, with or without DE/ED, is available. AIM The aim of this observational study was to develop and test a screening tool designed to identify female athletes at risk for the Triad. METHODS Female athletes (n=84) with 18-39 years of age and training ≥5 times/week filled out the Low Energy Availability in Females Questionnaire (LEAF-Q), which comprised questions regarding injuries and gastrointestinal and reproductive function. Reliability and internal consistency were evaluated in a subsample of female dancers and endurance athletes (n=37). Discriminant as well as concurrent validity was evaluated by testing self-reported data against measured current EA, menstrual function and bone health in endurance athletes from sports such as long distance running and triathlon (n=45). RESULTS The 25-item LEAF-Q produced an acceptable sensitivity (78%) and specificity (90%) in order to correctly classify current EA and/or reproductive function and/or bone health. CONCLUSIONS The LEAF-Q is brief and easy to administer, and relevant as a complement to existing validated DE screening instruments, when screening female athletes at risk for the Triad, in order to enable early detection and intervention.
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Affiliation(s)
- Anna Melin
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
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31
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Jackman SR, Scott S, Randers MB, Ørntoft C, Blackwell J, Zar A, Helge EW, Mohr M, Krustrup P. Musculoskeletal health profile for elite female footballers versus untrained young women before and after 16 weeks of football training. J Sports Sci 2013; 31:1468-74. [DOI: 10.1080/02640414.2013.796066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sarah R. Jackman
- a Sport and Health Sciences, College of Life and Environmental Sciences , University of Exeter , Exeter , UK
| | - Suzanne Scott
- a Sport and Health Sciences, College of Life and Environmental Sciences , University of Exeter , Exeter , UK
| | - Morten Bredsgaard Randers
- b Department of Nutrition, Exercise and Sports, Copenhagen Centre for Team Sport and Health , University of Copenhagen , Denmark
| | - Christina Ørntoft
- b Department of Nutrition, Exercise and Sports, Copenhagen Centre for Team Sport and Health , University of Copenhagen , Denmark
| | - Jamie Blackwell
- a Sport and Health Sciences, College of Life and Environmental Sciences , University of Exeter , Exeter , UK
| | - Abdossaleh Zar
- c Department of Physical Education & Sport Science , University of Jahrom , Islamic Republic of Iran
| | - Eva Wulff Helge
- b Department of Nutrition, Exercise and Sports, Copenhagen Centre for Team Sport and Health , University of Copenhagen , Denmark
| | - Magni Mohr
- a Sport and Health Sciences, College of Life and Environmental Sciences , University of Exeter , Exeter , UK
| | - Peter Krustrup
- a Sport and Health Sciences, College of Life and Environmental Sciences , University of Exeter , Exeter , UK
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Behrens SB, Deren ME, Matson A, Fadale PD, Monchik KO. Stress fractures of the pelvis and legs in athletes: a review. Sports Health 2013; 5:165-74. [PMID: 24427386 PMCID: PMC3658382 DOI: 10.1177/1941738112467423] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
CONTEXT Stress fractures are common injuries in athletes, often difficult to diagnose. A stress fracture is a fatigue-induced fracture of bone caused by repeated applications of stress over time. EVIDENCE ACQUISITION PubMed articles published from 1974 to January 2012. RESULTS Intrinsic and extrinsic factors may predict the risk of stress fractures in athletes, including bone health, training, nutrition, and biomechanical factors. Based on their location, stress fractures may be categorized as low- or high-risk, depending on the likelihood of the injury developing into a complete fracture. Treatment for these injuries varies substantially and must account for the risk level of the fractured bone, the stage of fracture development, and the needs of the patient. High-risk fractures include the anterior tibia, lateral femoral neck, patella, medial malleolus, and femoral head. Low-risk fractures include the posteromedial tibia, fibula, medial femoral shaft, and pelvis. Magnetic resonance is the imaging test of choice for diagnosis. CONCLUSIONS These injuries can lead to substantial lost time from participation. Treatment will vary by fracture location, but most stress fractures will heal with rest and modified weightbearing. Some may require more aggressive intervention, such as prolonged nonweightbearing movement or surgery. Contributing factors should also be addressed prior to return to sports.
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Affiliation(s)
- Steve B. Behrens
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Matthew E. Deren
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Andrew Matson
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Paul D. Fadale
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Keith O. Monchik
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Reed JL, De Souza MJ, Williams NI. Changes in energy availability across the season in Division I female soccer players. J Sports Sci 2013; 31:314-24. [DOI: 10.1080/02640414.2012.733019] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Duckham RL, Peirce N, Meyer C, Summers GD, Cameron N, Brooke-Wavell K. Risk factors for stress fracture in female endurance athletes: a cross-sectional study. BMJ Open 2012; 2:bmjopen-2012-001920. [PMID: 23166136 PMCID: PMC3533057 DOI: 10.1136/bmjopen-2012-001920] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To identify psychological and physiological correlates of stress fracture in female endurance athletes. DESIGN A cross-sectional design was used with a history of stress fractures and potential risk factors assessed at one visit. METHODS Female-endurance athletes (58 runners and 12 triathletes) aged 26.0±7.4 years completed questionnaires on stress fracture history, menstrual history, athletic training, eating psychopathology and exercise cognitions. Bone mineral density, body fat content and lower leg lean tissue mass (LLLTM) were assessed using dual-x-ray absorptiometry. Variables were compared between athletes with a history of stress fracture (SF) and those without (controls; C) using χ², analysis of variance and Mann-Whitney U tests. RESULTS Nineteen (27%) athletes had previously been clinically diagnosed with SFs. The prevalence of current a/oligomenorrhoea and past amenorrhoea was higher in SF than C (p=0.008 and p=0.035, respectively). SF recorded higher global scores on the eating disorder examination questionnaire (p=0.049) and compulsive exercise test (p=0.006) and had higher LLLTM (p=0.029) compared to C. These findings persisted with weight and height as covariates. In multivariate logistic regression, compulsive exercise, amenorrhoea and LLLTM were significant independent predictors of SF history (p=0.006, 0.009 and 0.035, respectively). CONCLUSIONS Eating psychopathology was associated with increased risk of SF in endurance athletes, but this may be mediated by menstrual dysfunction and compulsive exercise. Compulsive exercise, as well as amenorrhoea, is independently related to SF risk.
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Affiliation(s)
- Rachel L Duckham
- Centre for Global Health and Human Development, Loughborough University, SSEHS, Loughborough, Leicestershire, UK
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Abstract
The objective was to investigate the incidence, type and distribution of stress fractures in professional male football players. Fifty-four football teams, comprising 2379 players, were followed prospectively for 189 team seasons during the years 2001-2009. Team medical staff recorded individual player exposure and time-loss injuries. The first team squads of 24 clubs selected by UEFA as belonging to the 50 best European teams, 15 teams of the Swedish Super League and 15 teams playing their home matches on artificial turf pitches were included. In total, 51 stress fractures occurred during 1,180,000 h of exposure, giving an injury incidence of 0.04 injuries/1000 h. A team of 25 players can therefore expect one stress fracture every third season. All fractures affected the lower extremities and 78% the fifth metatarsal bone. Stress fractures to the fifth metatarsal bone, tibia or pelvis caused absences of 3-5 months. Twenty-nine percent of the stress fractures were re-injuries. Players that sustained stress fractures were significantly younger than those that did not. Stress fractures are rare in men's professional football but cause long absences. Younger age and intensive pre-season training appear to be risk factors.
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Affiliation(s)
- J Ekstrand
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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