The female athlete triad no pain, no gain?

[The psychological factors affecting athletic performance]

The physical and mental health complex is claimed as achievement of the XXI. century, whereby also among the sportsmen and sportswomen, beside the somatic medicine, growing attention is devoted to the psyche as well. The sports psychiatry was dragged in and put into service to enhance performance after all biological weapons run out of ammunition, and the long-awaited results still failed to come about. Moreover, despite the energy increasingly invested it was going from bad to worse. Among athletes many psychiatric disorders call attention, either by the high prevalence or by the development of a specific syndrome. Symptoms of depression (depression after the competition, depression following the failure at the competition), chronic stress, anxiety, fatigue syndrome of overtraining, enervation, sleep disturbances, eating problems, burnout, eating disorders (anorexia athletics, athlete triad), personality factors and the chemical addiction are all extremely important. The present study is the first to summarize the most crucial psychiatric disorders that may have great significance in the athlete population, in varying degrees according to the individual sports.

[Leptin: aspects on energetic balance, physical exercise and athletic amenorhea]

The aim of this manuscript was to review the knowledge about leptin, detailing its relationship with energetic intake and physical activity. Leptin is an adipocyte hormone, recognized mainly for its putative role in control of energy expenditure, food intake, body weight and reproductive function. Leptin has still important peripheral actions, including its role on the ovarian tissue. The intracellular signaling mechanisms are recognized in hypothalamus, but in peripheral tissue are not fully understood. The exercise, when practiced by women, if not appropriately planned according to food intake, can modify the leptin release. When energy imbalances induced by exercise and/or deficient food ingestion occurs, low leptin levels are observed, leading to a reduction in GnRH (gonadotropin-release hormone), in LH (luteinizing hormone) and FSH (follicle-stimulating hormone) in pituitary, and consequently a minor release of ovarian estrogens. This process is named hypothalamic amenorrhea, and has repercussions in the woman's health. In this perspective, it is important to emphasize the need to evaluate the energy expenditure from exercise and to formulate adequate alimentary plans to these individuals.

Use of the preparticipation physical exam in screening for the female athlete triad among high school athletes

The female athlete triad comprises 3 individual but interrelated conditions associated with athletic training: disordered eating, amenorrhea, and osteoporosis. Each condition is of medical concern, but when found within the triad, they can have serious medical consequences. The purpose of this study was to evaluate the effectiveness of preparticipation history and physical forms in high school athletic programs to screen for the triad, and to determine the prevalence of educational programs related to the female athlete triad. Results suggest that a majority of high school athletic programs are not adequately screening girls for the components of the triad, and schools lack educational programs targeting athletes and coaches. School nurses have the potential to play a vital role in the prevention and early identification of the triad through a preparticipation physical exam that specifically screens female athletes and in the implementation of educational programs for athletes and coaches regarding the disorders of the female athlete triad.

Early identification and interventions for female athlete triad

The diagnosis of female athlete triad is based on three criteria: (a) disordered eating, (b) amenorrhea, and (c) osteopenia. Prevention involves increasing awareness of this problem in athletes, parents, and coaches. Routine and opportunistic screening for risk factors by health care providers will increase early detection in athletes. Appropriate evaluation and treatment will decrease the consequences of this disorder. Consequences include stress fractures, development of eating disorders, and lower peak bone mass resulting in increased risk of osteoporosis later in life. A primary care case manager who provides motivation and support along with a multidisciplinary approach to treatment is recommended. This approach includes nutritional, exercise, and psychological therapies and possibly supplements and medication for optimal results.

Nutritional considerations for vegetarian athletes

With the growing interest in the potential health benefits of plant-based diets, it is relevant to consider whether vegetarian dietary practices could influence athletic performance. Accordingly, this review examines whether nutrients that may differ between vegetarian and omnivorous diets could affect physical performance. We also describe recent studies that attempt to assess the effects of a vegetarian diet on performance and comment on other nutritional aspects of vegetarianism of relevance to athletes. Although well-controlled long-term studies assessing the effects of vegetarian diets on athletes have not been conducted, the following observations can be made: 1) well-planned, appropriately supplemented vegetarian diets appear to effectively support athletic performance; 2) provided protein intakes are adequate to meet needs for total nitrogen and the essential amino acids, plant and animal protein sources appear to provide equivalent support to athletic training and performance; 3) vegetarians (particularly women) are at increased risk for non-anemic iron deficiency, which may limit endurance performance; and 4) as a group, vegetarians have lower mean muscle creatine concentrations than do omnivores, and this may affect supramaximal exercise performance. Because their initial muscle creatine concentrations are lower, vegetarians are likely to experience greater performance increments after creatine loading in activities that rely on the adenosine triphosphate/phosphocreatine system. 5) Coaches and trainers should be aware that some athletes may adopt a vegetarian diet as a strategy for weight control. Accordingly, the possibility of a disordered eating pattern should be investigated if a vegetarian diet is accompanied by unwarranted weight loss.