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Schulz JM, Pohlod L, Myers S, Chung J, Thornton JS. Are female athlete specific health considerations being assessed and addressed in preparticipation examinations? A scoping review and proposed framework. JOURNAL OF SPORT AND HEALTH SCIENCE 2024:100981. [PMID: 39244153 DOI: 10.1016/j.jshs.2024.100981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/24/2024] [Accepted: 04/23/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Preparticipation examinations (PPEs) are unstandardized screening tools routinely used to collect an athlete's baseline health information prior to the start of a new competitive season. However, many PPEs include minimal and often nonspecific questions related to the health concerns of female athletes. A lack of female athlete specific health questions could result in missed red flags and subsequent injury or illness. As such, the objectives of this scoping review were to (a) determine what female athlete specific health questions currently exist in PPEs in the scientific literature to prevent injury and illness, and (b) map the results against the health domains outlined in the International Olympic Committee (IOC) consensus statement supplement on the female athlete. METHODS We searched Embase, Scopus, CINAHL, Medline Ovid, and SPORTDiscus from inception to December 2022. Any study with female athlete specific health PPE questions or recommendations for questions (i.e., menstrual health, eating habits, musculoskeletal health, etc.) was included. Three reviewers independently screened titles and abstracts, followed by full text articles for eligibility and data extraction, with conflicts resolved by a third-party reviewer. Extracted data were summarized into 3 determined groupings. RESULTS Of the 1356 studies screened, 41 were included in this study. Forty studies (98%) included questions/recommendations related to menstrual health. Thirty-one studies (76%) had questions/recommendations concerning disordered eating/eating habits. Twenty-four studies (59%) referred to body weight/image, and 16 studies (39%) referred to musculoskeletal health. No studies included questions on all IOC female athlete health domains. CONCLUSION There is currently a gap in female athlete specific health content included in PPEs. A more comprehensive, standardized PPE with a focus on inclusion of female athlete specific health questions and considerations should be developed to improve health and optimal participation of female athletes around the world.
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Affiliation(s)
- Jenna M Schulz
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON N6G 2M1, Canada; Fowler-Kennedy Sport Medicine Clinic, Western University, London, ON N6A 3K7, Canada; Bone & Joint Institute, Western University, London, ON N6A 3K7, Canada.
| | - Lois Pohlod
- Clinical Masters in Sport and Exercise Medicine, Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Samantha Myers
- Fowler-Kennedy Sport Medicine Clinic, Western University, London, ON N6A 3K7, Canada; Clinical Masters in Sport and Exercise Medicine, Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Jason Chung
- Clinical Masters in Sport and Exercise Medicine, Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Jane S Thornton
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON N6G 2M1, Canada; Fowler-Kennedy Sport Medicine Clinic, Western University, London, ON N6A 3K7, Canada; Bone & Joint Institute, Western University, London, ON N6A 3K7, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON N6G 2M1, Canada; School of Kinesiology, Faculty of Health Sciences, Western University, London, ON N6A 3K7, Canada
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Hoenig T, Tenforde AS, Hollander K, Junge A, Branco P, Vinther A, Edouard P. Bone stress injuries in athletics (track and field) championships: findings from a prospective injury surveillance conducted across 24 international championships with 29,147 registered athletes. BMC Sports Sci Med Rehabil 2024; 16:173. [PMID: 39148110 PMCID: PMC11325730 DOI: 10.1186/s13102-024-00955-w] [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: 03/10/2024] [Accepted: 07/29/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Athletics (track and field) athletes are prone to develop bone stress injuries (BSIs) but epidemiological data on BSIs from top-level sports events are scarce. OBJECTIVE To describe the incidence and characteristics of BSIs during 24 international athletics championships held from 2007 to 2023. METHODS BSI-related data were prospectively collected during 24 international athletics championships, including the Olympic Games (n = 3), World Outdoor Championships (n = 4), European Outdoor Championships (n = 6), World Indoor Championships (n = 3) and European Indoor Championships (n = 8). Descriptive and comparative statistics were used to assess the epidemiological characteristics of BSIs. RESULTS BSIs accounted for 1.5% of all reported injuries (n = 36; 1.2 per 1000 registered athletes (95%CI 0.8 to 1.6)). No significant difference of BSI incidence was detected between female (2.0 per 1000 athletes (95%CI: 0.9 to 2.3)) and male athletes (0.9 per 1000 athletes (95%CI: 0.4 to 1.4)) (relative risk (RR) = 1.73, 95%CI: 0.88 to 3.40). BSI incidence was significantly higher during outdoor championships (1.6 per 1000 registered athletes (95%CI: 1.0 to 2.1)) as compared to indoor championships (0.2 per 1000 registered athletes (95%CI: 0.0 to 0.5)) (RR = 10.4, 95%CI: 1.43 to 76.0). Most BSIs were sustained in the foot (n = 50%) or leg (n = 33%). BSIs were reported in athletes participating in endurance disciplines (52.8%) or in explosive disciplines (47.2%). CONCLUSIONS BSIs represent a small portion of injuries sustained during international athletics championships. Collective results suggest that injury rates are higher in outdoor competitions as compared to indoor competitions. The most common injury locations comprise the foot and leg. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Tim Hoenig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Astrid Junge
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Center for Health in Performing Arts, MSH Medical School Hamburg, Hamburg, Germany
| | - Pedro Branco
- European Athletics Medical & Anti Doping Commission, European Athletics Association (EAA), Lausanne, Switzerland
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Hospital Secretariat and Communication, Research, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Pascal Edouard
- European Athletics Medical & Anti Doping Commission, European Athletics Association (EAA), Lausanne, Switzerland
- Inter-university Laboratory of Human Movement Science (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint Etienne, F-42023, France
- Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France
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Lodge MT, Ackerman KE, Garay J. Differences in Knowledge of Female Athlete Triad and Relative Energy Deficiency in Sport in Female Cross-Country Athletes. J Athl Train 2024; 59:836-844. [PMID: 38014797 PMCID: PMC11340665 DOI: 10.4085/1062-6050-0608.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND The female athlete triad (Triad) and relative energy deficiency in sport (REDs) describe potential health and performance consequences of low energy availability. OBJECTIVE We surveyed female cross-country athletes to assess differences in educational impact scores (EIS; knowledge score × confidence score factor) of Triad and REDs. Associations between EIS and participant characteristics (eg, mileage [current and peak], years of running experience, age, bone stress injury history, division level participation, academic area of study, Triad or REDs diagnoses, and Triad or REDs education) were explored. MAIN OUTCOME MEASURE(S) An evidence-based online survey was developed and administered via Qualtrics to female collegiate cross-country athletes (n = 275; age = 20 ± 1 years). RESULTS A weak correlation existed between peak career mileage and EIS (r = 0.195; P = .010). Educational impact scores significantly differed in athletes with a related academic area of study versus those without (21.91 ± 5.16 and 16.11 ± 5.54, respectively). Educational impact scores significantly differed in athletes with Triad and REDs diagnoses (21.69 ± 5.85 and 22.58 ± 6.82, respectively) versus those without (16.80 ± 6.54 and 17.20 ± 6.34, respectively). Educational impact scores were higher in those who had received Triad education versus those who had not (21.03 ± 6.86 and 18.12 ± 6.82, respectively). A significant interaction between peak career mileage and Triad diagnosis was found (P = .005). CONCLUSIONS Significant education-based and diagnosis differences suggest that Triad diagnoses correlate with peak career mileage. These findings support the facilitation of education to improve not only the treatment but also the prevention of Triad and REDs.
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Fatt SJ, George E, Hay P, Jeacocke N, Gotkiewicz E, Mitchison D. An Umbrella Review of Body Image Concerns, Disordered Eating, and Eating Disorders in Elite Athletes. J Clin Med 2024; 13:4171. [PMID: 39064211 PMCID: PMC11278087 DOI: 10.3390/jcm13144171] [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: 06/04/2024] [Revised: 07/07/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Several systematic reviews and meta-analyses have been conducted to date indicating a high prevalence of disordered eating in elite athletes and associated risk factors. However, the substantial time burden associated with locating and comparing these reviews, which are varied in methodology and sampling focus, may be a barrier for informing policy and best practice as well as directing future research. This umbrella review aimed to provide a summary of evidence across published reviews regarding the prevalence and risk factors for disordered eating (including body image concerns and eating disorders) in elite athletes. Methods: Five databases (CINAHL, PsycINFO, MEDLINE, Scopus, and SPORTDiscus) were systematically searched for peer-reviewed systematic reviews and meta-analyses that met the following inclusion criteria: (1) investigated prevalence and risk factors for disordered eating, (2) included a sample of elite athletes, and (3) available in English. The included studies underwent data extraction and risk of bias assessment using the AMSTAR 2. Results: The initial search identified 1828 articles that were screened for title and abstract and then full text, leaving 24 systematic reviews (including 10 meta-analyses). Disordered eating was prevalent across elite athletes, including males and females and across sport type. Elite athletes were at elevated risk for disordered eating and eating disorders but at lower risk for body image concerns versus non-athlete controls. Several risk factors were identified, including female gender, competing in lean sports, and experiencing career changes. Few reviews or meta-analyses examined perceived pressures within the sporting environment, and most had substantial risk of bias concerns. Conclusions: Elite athletes are at risk for the spectrum of disordered eating, and all should be considered for primary prevention and screening. Further research is needed regarding sport-specific versus general pressures and mediators of risk to better inform interventions.
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Affiliation(s)
- Scott J. Fatt
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown 2560, Australia; (E.G.); (P.H.); (D.M.)
| | - Emma George
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown 2560, Australia; (E.G.); (P.H.); (D.M.)
- School of Health Sciences, Western Sydney University, Campbelltown 2560, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown 2560, Australia; (E.G.); (P.H.); (D.M.)
- Mental Health Services, South Western Sydney Local Health District, Camden and Campbelltown Hospital, Campbelltown 2560, Australia
| | - Nikki Jeacocke
- AIS Performance, Australian Sports Commission, Bruce 2617, Australia;
| | - Emily Gotkiewicz
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown 2560, Australia; (E.G.); (P.H.); (D.M.)
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo 2008, Australia
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Lichtenstein MB, Hertz SPT, Johansen KK, Rytter J, Sundgot-Borgen J, Torstveit MK, Holm L, Melin AK. Are Sub-elite Athletes at Higher Risk of Eating Disorders, Exercise Addiction, Depression, and Low Energy Availability Compared With Elite Athletes? Clin J Sport Med 2024:00042752-990000000-00216. [PMID: 39012244 DOI: 10.1097/jsm.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 04/28/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE The main objective of this study was to investigate the risk of eating disorders, exercise addiction, depression, and low energy availability (LEA) in Danish female and male elite compared with sub-elite athletes. DESIGN A cross-sectional study. SETTING An online survey. PARTICIPANTS A total of 410 elite athletes (mean age 20.1 years, 51% females) and 206 sub-elite athletes (mean age 21.3 years, 52% females) from 15 different sports.Assessment of Risk Factors: Eating Disorders, exercise addiction, depression, and LEA. MAIN OUTCOME MEASURES The Sick Control, One Stone (6.5 kg), Fat, Food, the Eating Disorder Examination-Questionnaire, the Exercise Addiction Inventory, the Major Depression Inventory, and the Low Energy Availability in Females Questionnaire or the Low Energy Availability in Males Questionnaire. RESULTS We found that more female sub-elite athletes compared with elite athletes had risk of eating disorders (EDs) (37.4% vs 23.4%; P < 0.012) and the same was found for males (23.2% vs 10.4%; P = 0.005). More athletes with risk of EDs had risk of exercise addiction (12.8 vs 5.4%, P = 0.006), depression (27.3 vs 4.2%, P < 0.001), and LEA (females 55.1 vs 40.7%, P = 0.024, and males 29.4 vs 13.7%, P = 0.036, respectively) compared with athletes without risk of EDs. CONCLUSIONS Sub-elite athletes have a higher risk of eating disorders compared with elite athletes. Regular screening of ED symptoms and associated conditions in elite and especially sub-elite athletes may ensure early identification.
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Affiliation(s)
- Mia Beck Lichtenstein
- Department of Psychology, University of Southern Denmark, Denmark
- Centre for Digital Psychiatry, Odense, Denmark
| | | | | | - Josefine Rytter
- Department of Psychology, University of Southern Denmark, Denmark
- Centre for Digital Psychiatry, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
- Department of Sports Medicine, the Norwegian School of Sport Sciences, Oslo, Norway
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Team Danmark, The Danish Elite Sport Institution, Broendby, Denmark; and
- Department of Sports Science, Linnaeus University, Växjö/Kalmar, Sweden
| | - Jorunn Sundgot-Borgen
- Department of Psychology, University of Southern Denmark, Denmark
- Centre for Digital Psychiatry, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
- Department of Sports Medicine, the Norwegian School of Sport Sciences, Oslo, Norway
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Team Danmark, The Danish Elite Sport Institution, Broendby, Denmark; and
- Department of Sports Science, Linnaeus University, Växjö/Kalmar, Sweden
| | | | - Lars Holm
- Team Danmark, The Danish Elite Sport Institution, Broendby, Denmark; and
| | - Anna K Melin
- Department of Sports Science, Linnaeus University, Växjö/Kalmar, Sweden
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Dvořáková K, Paludo AC, Wagner A, Puda D, Gimunová M, Kumstát M. A literature review of biomarkers used for diagnosis of relative energy deficiency in sport. Front Sports Act Living 2024; 6:1375740. [PMID: 39070233 PMCID: PMC11273787 DOI: 10.3389/fspor.2024.1375740] [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: 01/24/2024] [Accepted: 06/17/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction The review aims to summarize the markers used in diagnosing relative energy deficiency in sport (REDs) and compare them with the REDs CAT2 score. Methods A systematic search was performed in the PubMed, Web of Science, and SPORTDiscus databases during April 2023. The descriptors used were "athlete" AND "REDs," along with respective entry terms. The selection process followed the PRISMA 2020 recommendations, identifying 593 records, from which 13 studies were ultimately selected. Seventy-nine markers were identified and categorized into six groups: bone mineral density (BMD), metabolic resting rate, blood biomarkers, anthropometrics, nutritional intake, and performance parameters. The most frequently utilized biomarkers included BMD, anthropometric parameters (e.g., body mass index, body mass, and fat mass), and the triiodothyronine (T3) concentration. Results According to the REDs CAT2 pointed indicators, the biomarkers varied among the studies, while 7 out of the 13 included studies achieved a ≥60% agreement rate with this tool. The prevalence of low energy availability, an etiological factor in the development of REDs, was detected in 4 out of 13 studies, with an average of 39.5%. Conclusion In conclusion, this review highlights the most commonly used markers in diagnosing REDs, such as BMD, anthropometric parameters, and T3 hormone concentration. Due to the current inconsistencies, standardizing diagnostic methodologies is crucial for future research. By focusing on widely used markers, this review aids future research planning and result interpretation and points out the ongoing need for methodological consistency in evolving diagnostic tools. Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO (CRD42022320007).
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Affiliation(s)
- Kristýna Dvořáková
- Department of Sport Performance and Exercise Testing, Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | - Ana Carolina Paludo
- Department of Sport Performance and Exercise Testing, Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | - Adam Wagner
- Department of Sport Performance and Exercise Testing, Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | - Dominik Puda
- Department of Sport Performance and Exercise Testing, Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | - Marta Gimunová
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | - Michal Kumstát
- Department of Sport Performance and Exercise Testing, Faculty of Sports Studies, Masaryk University, Brno, Czechia
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Jagim AR, Moschelli JS, Woodroffe LM, Horswill CA, Bloomfield SA, Oppliger RA. Contemporary Issue: Health and Safety of Female Wrestlers. Curr Sports Med Rep 2024; 23:262-269. [PMID: 38941548 DOI: 10.1249/jsr.0000000000001183] [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: 06/30/2024]
Abstract
ABSTRACT Female wrestling has grown exponentially over the past decade. Within the United States, 46 states now recognize female high school wrestling, and 153 colleges have programs. It is on track to become an NCAA championship-level sport in 2026. A primary health and safety risk among this cohort pertains to rapid weight loss strategies. These can lead to intentional caloric restriction and decreased body fatness, with the perceived goal of attaining a competitive advantage. Low energy availability and low body fatness are associated with a number of health concerns including menstrual dysfunction and loss of bone mineral density in girls and women. The current recommendation of 12% as a minimum for percentage body fat is very likely too low, opening the door for health perturbations among this population. The minimum threshold might more appropriately fall within the range of 18% to 20%. Body fat assessment methods, primarily skinfold measures that are used to guide weight class selection, have not been adequately validated among this population and therefore should be an area of research focus, while also exploring alternative assessment techniques. Further, we recommend that weight cycling, restrictive energy intake, and intentional dehydration be avoided. Research should assess the effects of frequent weight cycling (to "make weight") and prolonged periods of low body fat on the reproductive and bone health of these athletes. Finally, research and clinical evaluations on female wrestlers are limited, and we offer a list of research priorities for future investigation into this contemporary issue.
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Affiliation(s)
- Andrew R Jagim
- Sports Medicine, Mayo Clinic Health System, La Crosse, WI
| | - Jill S Moschelli
- Sports Medicine and Orthopedics, Michigan State University, East Lansing, MI
| | | | - Craig A Horswill
- Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
| | - Susan A Bloomfield
- Kinesiology and Sport Management, Texas A&M University - College Station, TX
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Blagrove RC, Brooke-Wavell K, Plateau CR, Nahman C, Hassan A, Stellingwerff T. The Role of Musculoskeletal Training During Return to Performance Following Relative Energy Deficiency in Sport. Int J Sports Physiol Perform 2024; 19:623-628. [PMID: 38834182 DOI: 10.1123/ijspp.2023-0532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/24/2024] [Accepted: 04/23/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Relative energy deficiency in sport (REDs) is a condition that is associated with negative health and performance outcomes in athletes. Insufficient energy intake relative to exercise energy expenditure, resulting in low energy availability, is the underlying cause, which triggers numerous adverse physiological consequences including several associated with musculoskeletal (MSK) health and neuromuscular performance. PURPOSE This commentary aims to (1) discuss the health and performance implications of REDs on the skeletal and neuromuscular systems and (2) examine the role that MSK training (ie, strength and plyometric training) during treatment and return to performance following REDs might have on health and performance in athletes, with practical guidelines provided. CONCLUSIONS REDs is associated with decreases in markers of bone health, lean body mass, maximal and explosive strength, and muscle work capacity. Restoration of optimal energy availability, mainly through an increase in energy intake, is the primary goal during the initial treatment of REDs with a return to performance managed by a multidisciplinary team of specialists. MSK training is an effective nonpharmacological component of treatment for REDs, which offers multiple long-term health and performance benefits, assuming the energy needs of athletes are met as part of their recovery. Supervised, prescribed, and gradually progressive MSK training should include a combination of resistance training and high-impact plyometric-based exercise to promote MSK adaptations, with an initial focus on achieving movement competency. Progressing MSK training exercises to higher intensities will have the greatest effects on bone health and strength performance in the long term.
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Affiliation(s)
- Richard C Blagrove
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Katherine Brooke-Wavell
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Carolyn R Plateau
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Carolyn Nahman
- Child and Adolescent Psychiatry, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Amal Hassan
- Institute of Sport, Exercise and Health, London, United Kingdom
| | - Trent Stellingwerff
- Canada Sport Institute-Pacific, Victoria, BC, Canada
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
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Crunkhorn ML, Toohey LA, Charlton P, Drew M, Watson K, Etxebarria N. Injury incidence and prevalence in elite short-course triathletes: a 4-year prospective study. Br J Sports Med 2024:bjsports-2023-107327. [PMID: 38331566 DOI: 10.1136/bjsports-2023-107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To characterise the prevalence, incidence rate (IR) and burden of injuries in elite short-course triathletes over a 4-year training and competition period. METHODS Fifty elite Australian triathletes were prospectively monitored for injury during four consecutive seasons (2018-2021). Injuries requiring medical attention were prospectively recorded and further subcategorised according to time loss. The IR and burden (injury IR×mean injury severity) were calculated per 365 athlete days, with sex differences in IR compared using IR ratios (IRR) from negative binomial regression models. RESULTS Two hundred and sixty-six injuries were reported in 46 (92.0%) athletes, of which 67.3% resulted in time loss. The injury IR was 1.87 injuries per 365 athlete days (95% CI 1.70 to 2.80), and comparable between sexes (IRR 0.82, 95% CI 0.64 to 1.04, p=0.109). Most injuries (70.7%) were training related. The most frequently injured body sites were the ankle (15.8%), foot (12.4%) and lower leg (12.0%). Bone stress injuries (BSIs) were the most burdensome injury type with 31.38 days of time loss per 365 days (95% CI 24.42 to 38.34). Twenty athletes (40.0%) reported at least one bone stress injury (BSI) (range 0-3). The rate of BSIs in female athletes was three times greater compared with male athletes (IRR 2.99, 95% CI 1.26 to 7.07, p=0.013). CONCLUSION Two-thirds of injuries reported in elite short-course triathletes resulted in time loss, with the majority occurring during training activities. Foot, ankle and other lower leg injuries had the highest incidence, with BSIs carrying the highest injury burden. The considerably higher rate of BSI observed in female athletes warrants consideration for future prevention strategies in female triathletes.
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Affiliation(s)
- Melissa Leith Crunkhorn
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
- Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Liam Anthony Toohey
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
- AIS Performance, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
| | - Paula Charlton
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
- Triathlon Australia, Gold Coast, Queensland, Australia
| | - Michael Drew
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
| | - Kate Watson
- Performance Health, Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Naroa Etxebarria
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
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Fahrenholtz IL, Melin AK, Garthe I, Wasserfurth P, Ivarsson A, Hollekim-Strand SM, Koehler K, Logue D, Madigan S, Gräfnings M, Torstveit MK. Short-term effects and long-term changes of FUEL-a digital sports nutrition intervention on REDs related symptoms in female athletes. Front Sports Act Living 2023; 5:1254210. [PMID: 38164441 PMCID: PMC10757931 DOI: 10.3389/fspor.2023.1254210] [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: 07/06/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
Female endurance athletes are at high risk for developing Relative Energy Deficiency in Sport (REDs), resulting in symptoms such as menstrual dysfunction and gastrointestinal (GI) problems. The primary aim of this study was to investigate effects of the FUEL (Food and nUtrition for Endurance athletes-a Learning program) intervention consisting of weekly online lectures combined with individual athlete-centered nutrition counseling every other week for sixteen weeks on REDs related symptoms in female endurance athletes at risk of low energy availability [Low Energy Availability in Females Questionnaire (LEAF-Q) score ≥8]. Female endurance athletes from Norway (n = 60), Sweden (n = 84), Ireland (n = 17), and Germany (n = 47) were recruited. Fifty athletes with risk of REDs (LEAF-Q score ≥8) and with low risk of eating disorders [Eating Disorder Examination Questionnaire (EDE-Q) global score <2.5], with no use of hormonal contraceptives and no chronic diseases, were allocated to either the FUEL intervention (n = 32) (FUEL) or a sixteen-week control period (n = 18) (CON). All but one completed FUEL and n = 15 completed CON. While no evidence for difference in change in LEAF-Q total or subscale scores between groups was detected post-intervention (BFincl < 1), the 6- and 12-months follow-up revealed strong evidence for improved LEAF-Q total (BFincl = 123) and menstrual score (BFincl = 840) and weak evidence for improved GI-score (BFincl = 2.3) among FUEL athletes. In addition, differences in change between groups was found for EDE-Q global score post-intervention (BFincl = 1.9). The reduction in EDE-Q score remained at 6- and 12- months follow-up among FUEL athletes. Therefore, the FUEL intervention may improve REDs related symptoms in female endurance athletes. Clinical Trial Registration www.clinicaltrials.gov (NCT04959565).
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Affiliation(s)
- Ida Lysdahl Fahrenholtz
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | | | - Ina Garthe
- The Norwegian Olympic and Paralympic Committee and Confederation of Sport, Oslo, Norway
| | - Paulina Wasserfurth
- Department Health and Sport Sciences, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Andreas Ivarsson
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Siri Marte Hollekim-Strand
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karsten Koehler
- Department Health and Sport Sciences, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Danielle Logue
- Sport Ireland Institute, National Sports Campus, Dublin, Ireland
| | - Sharon Madigan
- Sport Ireland Institute, National Sports Campus, Dublin, Ireland
| | - Maria Gräfnings
- Department of Medical Science, Dalarna University, Falun, Sweden
| | - Monica K. Torstveit
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
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11
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Stenqvist TB, Melin AK, Torstveit MK. Relative Energy Deficiency in Sport (REDs) Indicators in Male Adolescent Endurance Athletes: A 3-Year Longitudinal Study. Nutrients 2023; 15:5086. [PMID: 38140345 PMCID: PMC10745353 DOI: 10.3390/nu15245086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Longitudinal measurements of Relative Energy Deficiency in Sport (REDs) among adolescent male elite athletes are lacking. We aimed to monitor REDs indicators and their possible impact on performance in elite high-school cross-country skiing and biathlon athletes (n = 13) (16.3 ± 0.4 years, 179.4 ± 7.6 cm, 63.6 ± 8.2 kg body mass (BM), and peak oxygen uptake (VO2peak): 61.5 ± 5.3 mL/kg BM/min) every 6 months for 3 years. Protocols included assessments of energy availability (EA), body composition and bone mineral density (BMD), resting metabolic rate (RMR), disordered eating behavior, exercise addiction, VO2peak, and muscle strength. Data were analyzed using a linear mixed model. At baseline, 38% had low lumbar BMD (Z-score ≤ -1), and overall, bone health increased only slightly. VO2peak and muscle strength improved (p < 0.001), RMR decreased (p = 0.016), and no change was observed in EA or physiological or psychological REDs indicators. Conclusively, many of these young male athletes had poor bone health at baseline, and most either lost or did not achieve the expected pubertal bone mineral accrual, although no other indication of REDs was observed, while performance improved during the study period. Our findings highlight the importance of elite sports high schools focusing on screening for early detection of impaired bone health in male athletes.
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Affiliation(s)
- Thomas Birkedal Stenqvist
- Department of Sport Science and Physical Education, Faculty of Health and Sport Science, University of Agder, 4630 Kristiansand, Norway;
| | - Anna Katarina Melin
- Department of Sport Science, Faculty of Social Sciences, Linnaeus University, 351 95 Vaxjo, Sweden;
| | - Monica Klungland Torstveit
- Department of Sport Science and Physical Education, Faculty of Health and Sport Science, University of Agder, 4630 Kristiansand, Norway;
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12
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Fiorini S, Neri LDCL, Guglielmetti M, Pedrolini E, Tagliabue A, Quatromoni PA, Ferraris C. Nutritional counseling in athletes: a systematic review. Front Nutr 2023; 10:1250567. [PMID: 38053746 PMCID: PMC10694452 DOI: 10.3389/fnut.2023.1250567] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
Many studies report poor adherence to sports nutrition guidelines, but there is a lack of research on the effectiveness of nutrition education and behavior change interventions in athletes. Some studies among athletes demonstrate that nutrition education (NE), often wrongly confused with nutritional counseling (NC), alone is insufficient to result in behavior change. For this reason, a clear distinction between NC and NE is of paramount importance, both in terms of definition and application. NE is considered a formal process to improve a client's knowledge about food and physical activity. NC is a supportive process delivered by a qualified professional who guides the client(s) to set priorities, establish goals, and create individualized action plans to facilitate behavior change. NC and NE can be delivered both to individuals and groups. To our knowledge, the efficacy of NC provided to athletes has not been comprehensively reviewed. The aim of this study was to investigate the current evidence on the use and efficacy of nutritional counseling within athletes. A systematic literature review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. The search was carried out in: PubMed, Scopus, Web of Science, Science Direct, Cochrane Library between November 2022 and February 2023. Inclusion criteria: recreational and elite athletes; all ages; all genders; NC strategies. The risk of bias was assessed using the RoB 2.0 Cochrane tool. The quality of evidence checking was tested with the Mixed Methods Appraisal Tool system. From 2,438 records identified, 10 studies were included in this review, with athletes representing different levels of competition and type of sports. The most commonly applied behavior change theory was Cognitive Behavioral Theory. NC was delivered mainly by nutrition experts. The duration of the intervention ranged from 3 weeks to 5 years. Regarding the quality of the studies, the majority of articles reached more than 3 stars and lack of adequate randomization was the domain contributing to high risk of bias. NC interventions induced positive changes in nutrition knowledge and dietary intake consequently supporting individual performance. There is evidence of a positive behavioral impact when applying NC to athletes, with positive effects of NC also in athletes with eating disorders. Additional studies of sufficient rigor (i.e., randomized controlled trials) are needed to demonstrate the benefits of NC in athletes. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022374502.
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Affiliation(s)
- Simona Fiorini
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Lenycia De Cassya Lopes Neri
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Monica Guglielmetti
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Elisa Pedrolini
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Anna Tagliabue
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Paula A. Quatromoni
- Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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