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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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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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3
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Gimunová M, Bozděch M, Bernaciková M, Fernandes R, Kumstát M, Paludo A. The relationship between low energy availability, injuries, and bone health in recreational female athletes. PeerJ 2024; 12:e17533. [PMID: 38915384 PMCID: PMC11195543 DOI: 10.7717/peerj.17533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/17/2024] [Indexed: 06/26/2024] Open
Abstract
Background Low energy availability (LEA) causes pathophysiology of the female athlete's body affecting the bone and reproductive health and was observed to have a high prevalence in recreational female athletes previously. The aim of this study was to analyse the relationship between low energy availability in females questionnaire (LEAF-Q), bone mineral density (BMD), and postural stability in recreational athletes. Methods Recreational female athletes (n = 24, age: 23.71 ± 2.94, Tier I) completed LEAF-Q, postural stability measurement during quiet stance (Zebris platform FDM; GmbH) and their BMD was measured using DXA (Hologic QDR Horizon A). Non-parametric statistical tests were used to analyse the relationships between LEAF-Q, BMD, and postural stability and to compare differences between participants divided by the LEAF-Q score and its subscales. Results Risk of LEA was observed in 50% of recreational athletes participating in this study. Up to 46% of participants perceived menstrual bleeding changes related to training and 37.50% experienced menstrual dysfunction. Body composition and body weight fluctuations were observed to affect postural stability and BMD. With the risk score for LEA, the BMD and postural stability were not negatively affected in recreational athletes. However, the high number of recreational athletes in the risk score for LEA and menstrual dysfunctions highlights the need for public health programs aimed to increase awareness of LEA and its health consequences and for open communication about the menstrual cycle. Future longitudinal studies observing LEA, BMD, menstrual function, postural stability, and their interrelationship in female athletes are needed to increase the knowledge of this topic.
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Affiliation(s)
- Marta Gimunová
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Michal Bozděch
- Department of Physical Education and Social Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Martina Bernaciková
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Romulo Fernandes
- Laboratory of InVestigation in Exercise–LIVE, Department of Physical Education, Sao Paulo State University (UNESP), Sao Paulo, Brazil
| | - Michal Kumstát
- Department of Sport Performance and Exercise testing, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Ana Paludo
- Department of Sport Performance and Exercise testing, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
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Witkoś J, Luberda E, Błażejewski G, Strój E. Menstrual cycle disorders as an early symptom of energy deficiency among female physique athletes assessed using the Low Energy Availability in Females Questionnaire (LEAF-Q). PLoS One 2024; 19:e0303703. [PMID: 38848428 PMCID: PMC11161107 DOI: 10.1371/journal.pone.0303703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/29/2024] [Indexed: 06/09/2024] Open
Abstract
Physique competitions are weight-sensitive sports in which stage presentation, aesthetic appearance and posing ability of the athletes are judged rather than physical performance. The aim of this study was to assess low energy availability among female physique athletes by using the LEAF-Q. The study involved 104 females who were physique athletes. Monthly cycle disorders were reported in 58.65% of the women, that is periods stopped for three consecutive months or longer (amenorrhea). This situation occurred before the research was conducted in 43.27% of athletes and during the research in 15.38%. The physique athletes claimed that menstruation changes occurred when there was an increased exercise intensity, frequency or duration. Absence from training due to injury was reported by 27.88% of the women. The LEAF-Q identified 46.15% of the physique athletes as at risk (score ≥ 8) of low energy availability and the physiological consequences related to RED-S. Women who had menstrual cycle disorders were younger and did more training per week. Among women with menstrual disorders, cramps or stomach ache which cannot be related to menstruation occurred more frequently (p = 0.004). Absence from training or lack of participation in competition due to injuries occurred more frequently in the score ≥ 8 group (p = 0.024) thank the ≤ score 8 group. In the score ≥ 8 group menstruation changes, that is less bleeding or cessation of menstruation (p = 0.035), occurred more frequently when there was an increase in exercise intensity, frequency or duration (p = 0.002).
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Affiliation(s)
- Joanna Witkoś
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Edyta Luberda
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Grzegorz Błażejewski
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Ewa Strój
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
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Currie BM, Drew MK, Hetherington M, Waddington G, Brown NAT, Toohey LA. Diving Into the Health Problems of Competitive Divers: A Systematic Review of Injuries and Illnesses in Pre-elite and Elite Diving Athletes. Sports Health 2024:19417381241255329. [PMID: 38828690 DOI: 10.1177/19417381241255329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
CONTEXT The Olympic sport of diving involves the competitive disciplines of 3 m springboard and 10 m platform. Although it is generally accepted that lumbar spine injuries are common in diving athletes, the existing literature of health problems in diving athletes remains scarce. OBJECTIVE To identify the incidence, prevalence, and type of health problems that occur in competitive diving athletes. DATA SOURCES Medline, EMBASE, SportsDiscus, PsycINFO, and Google Scholar. STUDY SELECTION Studies written in English investigating elite or pre-elite competitive diving (springboard, platform) injuries and/or illnesses were eligible. Two independent reviewers screened for inclusion by title, abstract, and full text in accordance with the eligibility criteria. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Data extraction was completed by 1 author using a structured form. A second author then independently reviewed and verified the extracted data, any discrepancies were resolved through consensus. RESULTS The search identified 2554 potential articles, with 28 studies meeting eligibility criteria. The surveillance setting of most studies was restricted to competition-based events, with the reported injury incidence proportion ranging from 2.1% to 22.2%. The reported injury incidence rate ranged from 1.9 to 15.5 per 1000 athlete-exposures. Injuries to the shoulder, lower back/lumbar spine, trunk, and wrist/hand were reported most frequently. The prevalence of low back pain was reported as high as 89% (lifetime), 43.1% (period), and 37.3% (point). The illness incidence proportion ranged from 0.0% to 22.2%, with respiratory and gastrointestinal illness reported most frequently. CONCLUSION Up to 1 in 5 diving athletes sustain an injury and/or illness during periods of competition. A reporting bias was observed, with most cohort studies limiting surveillance to short competition-based periods only. This limits the current understanding of the health problems experienced by diving athletes to competition periods only and requires expansion to whole-of-year surveillance.
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Affiliation(s)
- Benjamin M Currie
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australia
- Diving Australia, Brisbane, Australia
- Queensland Academy of Sport, Sport Performance Innovation and Knowledge, Brisbane, Australia
| | - Michael K Drew
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australia
- Athlete Performance Health, Australian Institute of Sport, Bruce, Australia
| | | | - Gordon Waddington
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australia
- Sports Medicine, AIS Operations, Australian Institute of Sport, Bruce, Australia
| | - Nicholas A T Brown
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australia
| | - Liam A Toohey
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australia
- Athlete Performance Health, Australian Institute of Sport, Bruce, Australia
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Ghazzawi HA, Nimer LS, Haddad AJ, Alhaj OA, Amawi AT, Pandi-Perumal SR, Trabelsi K, Seeman MV, Jahrami H. A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide. J Eat Disord 2024; 12:24. [PMID: 38326925 PMCID: PMC10851573 DOI: 10.1186/s40337-024-00982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence. METHODS Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors. RESULTS The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I2 = 97.4%, τ2 = 0.8990, Cochran's Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE. CONCLUSION The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete's life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.
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Affiliation(s)
- Hadeel A Ghazzawi
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Lana S Nimer
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Areen Jamal Haddad
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Omar A Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Adam T Amawi
- Department of Exercise Science and Kinesiology, School of Sport Science, The University of Jordan, Amman, Jordan
| | - Seithikurippu R Pandi-Perumal
- Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
- Division of Research and Development, Lovely Professional University, Phagwara, Punjab, 144411, India
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, 3000, Sfax, Tunisia
- Research Laboratory: Education, Motricity, Sport and Health, University of Sfax, EM2S, LR19JS013000, Sfax, Tunisia
| | - Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Haitham Jahrami
- Ministry of Health, Manama, Bahrain.
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
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Torres-McGehee TM, Uriegas NA, Hauge M, Monsma EV, Emerson DM, Smith AB. Eating Disorder Risk and Pathogenic Behaviors Among Collegiate Student-Athletes. J Athl Train 2023; 58:803-812. [PMID: 37459386 PMCID: PMC11215712 DOI: 10.4085/1062-6050-0539.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
CONTEXT Eating disorders (EDs) are a cluster of behavioral conditions characterized by uneasy thoughts and behaviors that grow into severe or persistent eating disturbances. The demands on student-athletes may create mental and physical stressors that increase the likelihood of EDs and disordered eating. OBJECTIVE To examine the ED risk through eating attitudes and behaviors in male and female student-athletes and across various sport types (endurance, aesthetic, power, ball or team, or technical sports). DESIGN Cross-sectional study. SETTING Collegiate athletics. PATIENTS OR OTHER PARTICIPANTS National Collegiate Athletic Association Division I and II student-athletes (n = 2054; males = 631; females = 1423) from 40 institutions. MAIN OUTCOME MEASURE(S) Participants completed a web-based demographic survey and the Eating Attitudes Test-26 (EAT-26). Multiple χ2 analyses examined participants classified as at risk for EDs. Independent-samples t tests and a 1-way analyses of variance compared sex and sport type across EAT-26 totals and subscale (Dieting, Bulimia, and Oral Control) scores. RESULTS Overall, 25.3% (n = 520/2054) of student-athletes were classified as at risk for EDs. Differences were found between sex and ED risk (χ21,2054 = 32.9, P ≤ .01; 17.3% [n = 109/631] males, 28.9% [n = 411/1423] females) and across ED risk and sport type (χ24,2054 = 13.4, P = .01). When examining females only, we observed differences across ED risk and sport type (χ24,1423 = 13.4, P ≤ .01). No differences were evident across ED risk and sport type for males. Differences were seen between sex and binge eating (χ21,2054 = 6.8, P = .009), sex and diet pill use (χ21,2054 = 19.6, P ≤ .01), and sport type and diet pill use (χ24,2054= 12.2, P = .016), excessive exercise (χ24,2054 = 32.1, P ≤ .01), and losing more than 20 lb (9 kg) in the last 6 months (χ24,2054 = 10.2, P ≤ .037). CONCLUSIONS Student-athletes in the collegiate setting are at risk for EDs. Medical professionals, such as athletic trainers, need to be educated on the potential risk factors that may lead to EDs. Protocols for prevention, screening and recognition, and referral should be developed for student-athletes at risk for EDs.
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Taim BC, Ó Catháin C, Renard M, Elliott-Sale KJ, Madigan S, Ní Chéilleachair N. The Prevalence of Menstrual Cycle Disorders and Menstrual Cycle-Related Symptoms in Female Athletes: A Systematic Literature Review. Sports Med 2023; 53:1963-1984. [PMID: 37389782 DOI: 10.1007/s40279-023-01871-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Menstrual cycle (MC) disorders and MC-related symptoms can have debilitating effects on the health and performance of female athletes. As the participation of women in sports continues to increase, understanding the prevalence of a range of MC disorders and MC-related symptoms may guide preventive strategies to protect the health and optimise the performance of female athletes. OBJECTIVE To examine the prevalence of MC disorders and MC-related symptoms among female athletes who are not using hormonal contraceptives and evaluate the assessment methods used to identify MC disorders and MC-related symptoms. METHODS This systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Six databases were searched until September 2022 for all original research that reported the prevalence of MC disorders and/or MC-related symptoms in athletes not using hormonal contraceptives, which included the definitions of the MC disorders examined, and the assessment methods used. MC disorders included amenorrhoea, anovulation, dysmenorrhoea, heavy menstrual bleeding (HMB), luteal phase deficiency (LPD), oligomenorrhoea, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). MC-related symptoms included any affective and physical symptoms related to the MC that do not cause significant personal, interpersonal or functional impairment. The prevalence data across eligible studies were combined, and all studies were qualitatively synthesised to evaluate the assessment methods and tools used to identify MC disorders and MC-related symptoms. The methodological quality of studies was assessed using a modified Downs and Black checklist. RESULTS Sixty studies involving 6380 athletes were included. A wide range of prevalence was observed for all types of MC disorders, with a dearth of data on anovulation and LPD. Based on pooled data, dysmenorrhoea (32.3%; range 7.8-85.6%) was the most prevalent MC disorder. Studies reporting MC-related symptoms mostly examined the premenstrual and menstruation phases, where affective symptoms appeared more prevalent than physical symptoms. A larger proportion of athletes reported symptoms during the initial days of menstruation compared with the premenstrual phase. MC disorders and MC-related symptoms were retrospectively assessed using self-report methods in 90.0% of studies. Most studies (76.7%) in this review were graded as moderate quality. DISCUSSION MC disorders and MC-related symptoms are commonplace among female athletes, warranting further research examining their impact on performance and preventive/management strategies to optimise athlete health. To increase the quality of future studies, researchers should adopt standardised definitions of MC disorders and assessment methods such as a combination of calendar counting, urinary ovulation tests and a mid-luteal phase serum progesterone measurement when assessing menstrual function. Similarly, standardised diagnostic criteria should be used when examining MC disorders such as HMB, PMS and PMDD. Practically, implementing prospective cycle monitoring that includes ovulation testing, mid-luteal blood sampling (where feasible) and symptom logging throughout the MC could support athletes and practitioners to promptly identify and manage MC disorders and/or MC-related symptoms. TRIAL REGISTRATION This review has been registered in the PROSPERO database (CRD42021268757).
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Affiliation(s)
- Bernadette Cherianne Taim
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland.
- SHE Research Group, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland.
| | - Ciarán Ó Catháin
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
- SHE Research Group, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
| | - Michèle Renard
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
- SHE Research Group, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
| | - Kirsty Jayne Elliott-Sale
- Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, 99 Oxford Road, M1 7EL, Manchester, UK
| | - Sharon Madigan
- Sport Ireland Institute, Dublin, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Niamh Ní Chéilleachair
- Department of Sport and Health Sciences, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
- SHE Research Group, Technological University of the Shannon: Midlands Midwest, University Road, Athlone, N37 HD68, Westmeath, Ireland
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Stellingwerff T, Mountjoy M, McCluskey WT, Ackerman KE, Verhagen E, Heikura IA. Review of the scientific rationale, development and validation of the International Olympic Committee Relative Energy Deficiency in Sport Clinical Assessment Tool: V.2 (IOC REDs CAT2)-by a subgroup of the IOC consensus on REDs. Br J Sports Med 2023; 57:1109-1118. [PMID: 37752002 DOI: 10.1136/bjsports-2023-106914] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/28/2023]
Abstract
Relative Energy Deficiency in Sport (REDs) has various different risk factors, numerous signs and symptoms and is heavily influenced by one's environment. Accordingly, there is no singular validated diagnostic test. This 2023 International Olympic Committee's REDs Clinical Assessment Tool-V.2 (IOC REDs CAT2) implements a three-step process of: (1) initial screening; (2) severity/risk stratification based on any identified REDs signs/symptoms (primary and secondary indicators) and (3) a physician-led final diagnosis and treatment plan developed with the athlete, coach and their entire health and performance team. The CAT2 also introduces a more clinically nuanced four-level traffic-light (green, yellow, orange and red) severity/risk stratification with associated sport participation guidelines. Various REDs primary and secondary indicators have been identified and 'weighted' in terms of scientific support, clinical severity/risk and methodological validity and usability, allowing for objective scoring of athletes based on the presence or absence of each indicator. Early draft versions of the CAT2 were developed with associated athlete-testing, feedback and refinement, followed by REDs expert validation via voting statements (ie, online questionnaire to assess agreement on each indicator). Physician and practitioner validity and usability assessments were also implemented. The aim of the IOC REDs CAT2 is to assist qualified clinical professionals in the early and accurate diagnosis of REDs, with an appropriate clinical severity and risk assessment, in order to protect athlete health and prevent prolonged and irreversible outcomes of REDs.
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Affiliation(s)
- Trent Stellingwerff
- Canadian Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Margo Mountjoy
- Association for Summer Olympic International Federations (ASOIF), Lausanne, Switzerland
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports and Department of Public and Occupational Health, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Ida A Heikura
- Canadian Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
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Greenspan S, Stuckey MI. Untangling risk factors including discipline-specific exposure for injuries in preprofessional and professional circus artists in the USA. BMJ Open Sport Exerc Med 2023; 9:e001551. [PMID: 37216051 PMCID: PMC10193055 DOI: 10.1136/bmjsem-2023-001551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Objective This prospective cohort study quantified injury patterns related to specific circus discipline exposure in preprofessional and professional circus artists. Methods Circus artists (n=201; ages 13-69; 172 female, 29 male assigned sex at birth) were enrolled in 10 cities across the USA. Participants were followed for 1 year from enrolment, completing a weekly training log and undergoing a physical therapist evaluation for injuries. The circus-specific extension of the International Olympic Committee 2020 consensus on recording injury and illness in sports was used to analyse injury patterns. Results The study completion rate was 77% (n=155). Data were analysed by participant subgroup (age, professional status, sex at birth). The highest injury rates in participant subgroups were for males (5.69/1000 exposures) and related to discipline subgroups, were in aerial with ground elements (5.93/1000 exposures) and aerial (4.26/1000 exposures). Adults had more injuries related to aerial, whereas adolescents had more related to ground disciplines (χ2 (2)=10.62, p=0.005) and non-time loss injuries (χ2 (1)=5.45, p=0.02). Females had a higher proportion of repetitive injuries (70% vs 55%) than males (χ2 (1) = 4.43, p=0.035). Individuals with an eating disorder history had more (p<0.004) injuries (mean 2.27±2.29) than those without (mean=1.48±0.96). Conclusions This study showed that intrinsic factors (age, sex at birth and history of eating disorder) and extrinsic factors (circus discipline exposure) affect injury risk. We need to account for the intersectionality of these factors to address risk management at an individual and group level.
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Affiliation(s)
- Stephanie Greenspan
- Physical Therapy, Samuel Merritt University, Oakland, CA, USA
- Artletic Science, Oakland, CA, USA
| | - Melanie I Stuckey
- Centre de recherche, d'innovation et de transfert en arts du cirque, École nationale de cirque, Montréal, Quebec, Canada
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Marzuki MIH, Mohamad MI, Chai WJ, Farah NMF, Safii NS, Jasme JK, Jamil NA. Prevalence of Relative Energy Deficiency in Sport (RED-S) among National Athletes in Malaysia. Nutrients 2023; 15:nu15071697. [PMID: 37049534 PMCID: PMC10096906 DOI: 10.3390/nu15071697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Relative energy deficiency in sport (RED-S), which underpins the concept of low energy availability (LEA), can negatively affect athletes’ health and performance. This study aims to investigate the prevalence of RED-S among national athletes in Malaysia. A total of 192 national athletes (97 males, 18–39 years old) responded to an online survey regarding the RED-S risk. Most athletes (67.2%) were classified as having a medium/high RED-S risk. Female (41.2%), weight-class (23.9%), and intermittent sports (20.3%) had the highest prevalence of medium/high RED-S risk. Overall, most athletes spent 2–5 h daily (55.2%) and 6–7 days weekly (53.6%) practicing or playing their sport, and 47.9% reported feeling tired recently. The athletes were also terrified of being overweight (61.5%), worried about what they eat (64.7%), concerned about having fat on their bodies (62.6%), and thinking about burning calories while exercising (69.3%). Only 16.7% of the athletes had a prior history of stress fractures, and 40.6% continued to participate in activities 6–7 days per week while injured. The majority of female athletes (88.3%) had regular menstrual cycles. These findings support the notion that RED-S screening should be addressed in the athletic community. Future research is needed to clinically assess these athletes and investigate the impacts of RED-S on their health and sports performance.
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Affiliation(s)
- Muhammad Irfan Haiqal Marzuki
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
| | - Mohd Izham Mohamad
- Sports Nutrition Centre, National Sports Institute of Malaysia, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Wen Jin Chai
- Sports Nutrition Centre, National Sports Institute of Malaysia, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Nor M. F. Farah
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
| | - Nik Shanita Safii
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
| | - Jasmiza Khuzairi Jasme
- Sports Medicine Centre, National Sports Institute of Malaysia, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Nor Aini Jamil
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
- Correspondence:
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Witkoś J, Błażejewski G, Gierach M. The Low Energy Availability in Females Questionnaire (LEAF-Q) as a Useful Tool to Identify Female Triathletes at Risk for Menstrual Disorders Related to Low Energy Availability. Nutrients 2023; 15:nu15030650. [PMID: 36771357 PMCID: PMC9920150 DOI: 10.3390/nu15030650] [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: 12/31/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Nutrition in sport is a priority; it is the basis for maintaining optimal health and a prerequisite for the high performance necessary for competitions. The aim of this study was to assess low energy availability and its possible consequences among female triathletes by using the Low Energy Availability in Females Questionnaire (LEAF-Q). METHODS The study involved 30 female triathetes. The LEAF-Q was used in the study. An analysis of the body composition was carried out with the seca device mBCA 515 medical Body Composition Analyzer. RESULTS Of the 30 female triathletes studied, 23.3% had a monthly cycle disorder, defined as an amenorrhea state for more than 90 days. No differences were found in injury rates or training days lost to injury due to menstrual disturbances. Menstruation changes were significantly greater due to increases in exercise intensity, frequency, and duration in the group experiencing menstrual disturbances (85.7 [95% CIs: 42.1-99.6] vs. 8.7 [95% CIs: 1.1-28.0]). The menstrual disorder group had a greater incidence of their periods stopping for more than 3 months than the group without menstrual disturbances. CONCLUSIONS The female triathletes did not show abnormalities in body weight or composition, and these were not related to the incidence of menstrual disturbances. However, 20% of the triathletes either had, at the time of the study, or had had in the past monthly cycle disorders that could indicate an immediate risk of low energy availability. The LEAF-Q identified 10% of the triathletes as at risk (score > 8) of low energy availability and the physiological and performance consequences related to relative energy deficiency in sports (RED-S).
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Affiliation(s)
- Joanna Witkoś
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, G. Herlinga-Grudzińskiego Street 1, 30-705 Krakow, Poland
- Correspondence:
| | - Grzegorz Błażejewski
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, G. Herlinga-Grudzińskiego Street 1, 30-705 Krakow, Poland
| | - Marcin Gierach
- Department of Endocrinology and Diabetology, Collegium Medicum, Nicolaus Copernicus University, Skłodowskiej-Curie Street 9, 85-094 Bydgoszcz, Poland
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Gimunová M, Paulínyová A, Bernaciková M, Paludo AC. The Prevalence of Menstrual Cycle Disorders in Female Athletes from Different Sports Disciplines: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114243. [PMID: 36361122 PMCID: PMC9658102 DOI: 10.3390/ijerph192114243] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/28/2022] [Accepted: 10/10/2022] [Indexed: 05/05/2023]
Abstract
The aim of this study was to rapidly review the literature on the prevalence of menstrual disorders in female athletes from different sports modalities. Articles were searched in the Web of Science and PubMed database in May 2022. A total of 1309 records were identified, and 48 studies were included in the final stage. The menstrual disorders described in the included studies were primary (in 33% of included studies) and secondary amenorrhea (in 73% of included studies) and oligomenorrhea (in 69% of included studies). The prevalence of menstrual disorders among the studies ranged from 0 to 61%. When data were pooled according to discipline (mean calculation), the highest prevalence of primary amenorrhea was found in rhythmic gymnastics (25%), soccer (20%) and swimming (19%); for secondary amenorrhea in cycling (56%), triathlon (40%) and rhythmic gymnastics (31%); and oligomenorrhea in boxing (55%), rhythmic gymnastics (44%) and artistic gymnastics (32%). Based on the results of this review, the study supports the literature of the higher prevalence of menstrual disorders in gymnastics and endurance disciplines. However, team sports modalities such as volleyball and soccer also presented a considerable percentage of menstrual disorders compared to the general population. It reinforces the importance of coaches and physicians paying attention to athletes' menstrual cycle as the occurrence of menstrual disorders can be associated with impairment on some health components.
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Affiliation(s)
- Marta Gimunová
- Department of Kinesiology, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
- Correspondence:
| | - Alexandra Paulínyová
- Department of Kinesiology, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
| | - Martina Bernaciková
- Department of Kinesiology, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
| | - Ana Carolina Paludo
- Incubator of Kinanthropological Research, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
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Tanous D, Wagner KH, Leitzmann C, Motevalli M, Wirnitzer G, Rosemann T, Knechtle B, Wirnitzer K. Dietary Intake of Recreational Endurance Runners Associated with Race Distance-Results from the NURMI Study (Step 2). Nutrients 2022; 14:nu14183698. [PMID: 36145075 PMCID: PMC9503531 DOI: 10.3390/nu14183698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
While the popularity of distance running is growing worldwide, endurance runners’ dietary challenges associated with their prolonged training and racing activities have not yet been fully understood. The present investigation was conducted with the aim of examining the association between race distance and dietary intake of distance runners. A total of 317 runners initially participated, and after data clearance, 211 endurance runners (57% females) were finally considered the study sample. Runners were assigned to three race distance groups: 10-km (n = 74), half-marathon (n = 83), and marathon/ultra-marathon (n = 54). An online survey was used to collect data; dietary intake was monitored using a comprehensive food frequency questionnaire, including 53 food groups categorized in 14 basic and three umbrella clusters. There was no significant difference (p > 0.05) between race distance groups in consumption of most food clusters except for “fruits and vegetables” and “total of protein”, with a predominance of 10-km runners compared to half-marathoners and (ultra-)marathoners (p ≤ 0.05). Age was a significant predictor for the consumption of only five (out of 17) food clusters (p ≤ 0.05), including “fruit and vegetables”, “unprocessed meat”, “processed meat”, “eggs”, and “plant protein”. Future investigations with a larger sample size and more differentiated (sub)groups may help provide comparable data to develop a better understanding of the dietary behaviors among shorter versus longer distance runners.
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Affiliation(s)
- Derrick Tanous
- Department of Sport Science, Leopold-Franzens University of Innsbruck, 6020 Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
| | - Karl-Heinz Wagner
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria
| | - Claus Leitzmann
- Institute of Nutrition, University of Gießen, 35390 Gießen, Germany
| | - Mohamad Motevalli
- Department of Sport Science, Leopold-Franzens University of Innsbruck, 6020 Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland
| | - Katharina Wirnitzer
- Department of Sport Science, Leopold-Franzens University of Innsbruck, 6020 Innsbruck, Austria
- Department of Research and Development in Teacher Education, University College of Teacher Education Tyrol, 6010 Innsbruck, Austria
- Research Center Medical Humanities, Leopold-Franzens University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence:
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15
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Joubert L, Warme A, Larson A, Grønhaug G, Michael M, Schöffl V, Burtscher E, Meyer N. Prevalence of amenorrhea in elite female competitive climbers. Front Sports Act Living 2022; 4:895588. [PMID: 36032265 PMCID: PMC9400828 DOI: 10.3389/fspor.2022.895588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Elite competitive sport climbers exhibit a high strength-to-weight ratio and are reported in the literature to be lighter and leaner than their athletic counterparts. Current research regarding nutrition among climbers is sparse but suggests that they may be at high risk for low energy availability and Relative Energy Deficiency in Sport (RED-S). The prevalence of amenorrhea, one of the primary indicators of RED-S, is unknown in this athletic population. The purpose of this study was to determine the prevalence of current (previous 12 months) amenorrhea among elite level competitive sport climbers.MethodsAn anonymous online survey was distributed via email to 1,500 female climbers registered as competitors within the International Federation of Sport Climbing to assess the prevalence of amenorrhea over the past 12 months.ResultsA total of 114 female sport climbers answered all survey questions regarding menstrual function and 18 athletes (15.8%) presented with current amenorrhea. The majority of the athletes (72%; n = 82) were categorized with eumenorrhea. An additional 14 athletes (12.3%) provided information that indicated irregular cycles, but answers to all menstrual cycle questions were not congruent to elicit a classification of amenorrhea and these athletes were categorized with a menstrual status of unsure. The average BMI for climbers with eumenorrhea was 20.8 ± 1.8 kg/m2 and 19.9 ± 2.4 kg/m2 for those with amenorrhea. A higher percentage of climbers with amenorrhea revealed they currently struggle with an eating disorder compared to those without amenorrhea (13.5 vs. 22.2%, respectively).ConclusionThis study indicates that some female climbers competing at the World Cup level do have menstrual disturbances with relatively normal BMIs and some currently struggle with one or more eating disorders. Even though World Cup competitions use BMI critical margins to screen competitors, this research highlights the need for more medical supervision of competitive elite female sport climbers in order to protect their overall health, including menstrual function. Further research is required to clarify how many climbers suffer from endocrine abnormalities related to RED-S. With more scientific evidence in this area practitioners will be better equipped to educate the athlete and coach with evidence-based nutrition recommendations.
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Affiliation(s)
- Lanae Joubert
- School of Health and Human Performance, Northern Michigan University, Marquette, MI, United States
- *Correspondence: Lanae Joubert
| | - Amity Warme
- Department of Human Physiology and Nutrition, William J. Hybl Sports Medicine and Performance Center, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Abigail Larson
- Department of Kinesiology and Outdoor Recreation, Southern Utah University, Cedar City, UT, United States
| | - Gudmund Grønhaug
- Department of Sport, Food and Natural Sciences Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Campus Sogndal, Norway
| | | | - Volker Schöffl
- Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany
- School of Clinical and Applied Sciences, Leeds Becket University, Leeds, United Kingdom
- Department of Orthopedic and Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado Boulder, Boulder, CO, United States
- Medical Commission of the International Federation of Sport Climbing, Turino, Italy
| | - Eugen Burtscher
- Medical Commission of the International Federation of Sport Climbing, Turino, Italy
| | - Nanna Meyer
- Department of Human Physiology and Nutrition, William J. Hybl Sports Medicine and Performance Center, University of Colorado Colorado Springs, Colorado Springs, CO, United States
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Dietary Intake of Vegan and Non-Vegan Endurance Runners—Results from the NURMI Study (Step 2). Nutrients 2022; 14:nu14153151. [PMID: 35956327 PMCID: PMC9370654 DOI: 10.3390/nu14153151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023] Open
Abstract
Nowadays, the growing popularity of distance running has been accompanied by the increasing prevalence of vegan and vegetarian diets, especially among endurance athletes. The present study aimed to examine the association between diet type and dietary intake of distance runners competing at distances longer than 10 km. From a total of 317 participants, 211 endurance runners (57% females) were considered the final sample after applying the exclusion criteria. Runners were assigned to three groups based on the self-reported diet types: 95 omnivores, 40 vegetarians, and 76 vegans. Data collection was conducted using an online survey with questions about sociodemographic information, dietary intake, and dietary-associated motives. A comprehensive food frequency questionnaire with 53 food groups (categorized in 14 basic—plus three umbrella—food clusters) was used to assess dietary intake. Vegan runners had a higher intake of “beans and seeds”, “fruit and vegetables”, and “dairy alternatives”, as well as lower intakes of “oils” than other two groups. Vegetarian runners had a lower intake of “dairy products” and “eggs” than omnivores. A greater intake of “alcohol” and a lower intake of “meat alternatives” was observed in omnivorous runners compared to vegans and vegetarians. Despite the existence of a tendency toward the consumption of health-related food clusters by vegan runners, further investigations are needed to verify the predominance of vegans in health-oriented dietary patterns.
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17
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(Low) Energy Availability and Its Association with Injury Occurrence in Competitive Dance: Cross-Sectional Analysis in Female Dancers. Medicina (B Aires) 2022; 58:medicina58070853. [PMID: 35888572 PMCID: PMC9319529 DOI: 10.3390/medicina58070853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: The risk of low energy availability is related to various health problems in sports. This cross-sectional study aimed to identify a possible association between various dance factors, anthropometrics/body build, and energy availability with injury occurrence in contemporary dancers. Materials and Methods: The participants were 50 female competitive dancers (19.8 ± 4.1 years of age). The independent variables included age, dance factors (amount of training and competitions per week–exposure time, experience in dance), anthropometrics/body composition (body height, mass, BMI, body fat percentage (BF%), and fat-free mass (FFM)), and energy availability score (EAS; evaluated by accelerometer-based measurement of energy expenditure and Dance Energy Availability Questionnaires). The dependent variables were the occurrence of (i) soft-tissue injuries and (ii) bone injuries. The measurements were obtained by experienced technicians during the pre-competition period for each specific dance discipline. Univariate and multivariate logistic regressions were calculated to identify the associations between independent variables and injury prevalence. Results: The results showed that EAS (OR = 0.81, 95% CI:0.65–0.91), age (OR = 1.65, 95% CI: 1.1–2.46), higher BF% (OR = 1.23, 95% CI: 1.04–1.46) and BMI (OR = 1.61, 95% CI: 1.05–2.47) were correlated with soft-tissue injuries. Dancers who suffered from bone injuries reported higher exposure time (OR = 1.21, 95% CI: 1.05–1.37) and had lower values of FFM (OR = 0.73, 95% CI: 0.56–0.98). Multivariate regression analyses evidenced a higher likelihood of soft-tissue injuries in older dancers (OR = 1.75, 95% CI: 1.21–2.95) and the ones who had lower EAS (OR = 0.84, 95% CI: 0.71–0.95) while the exposure time was associated with a higher likelihood of bone injuries (OR = 1.21, 95% CI: 1.05–1.39). Conclusions: In order to decrease the injury prevalence among dancers, special attention should be paid to maintaining adequate nutrition that will provide optimal available energy for the demands of training and performing. Additionally, the control of training volume should be considered in order to reduce traumatic bone injuries.
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Dervish RA, Wilson LJ, Curtis C. Investigating the prevalence of low energy availability, disordered eating and eating disorders in competitive and recreational female endurance runners. Eur J Sport Sci 2022; 23:869-876. [PMID: 35582863 DOI: 10.1080/17461391.2022.2079423] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Eating disorders (ED), disordered eating (DE) and low energy availability (LEA) can be detrimental to health and performance. Previous studies have independently investigated prevalence of ED, DE or LEA, however limited studies have combined methods identifying risk within female runners. The aim of this study was to identify prevalence of ED, DE and LEA in United Kingdom-based female runners and associations between age, competition level and running distance. 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 n = 524 responses eligible for analysis were received. A total of n = 248 (47.3%), n = 209 (40%) and n = 49 (9.4%) athletes were at risk of LEA, DE and ED, respectively. LEAF-Q scores differed based upon age (Age: H(3) = 23.998, p≤0.05) and competitive level (Comp: H(1) = 7.682, p≤0.05) whereas FAST scores differed based on age (Age: F(3,523) = 4.753, p≤0.05). Tukey's post-hoc tests showed significantly higher FAST scores in 18-24 years compared to all other age categories (p≤0.05). Stepwise multiple regression demonstrated age and competitive level modestly predicted LEAF-Q scores (R2adj = 0.047, F(2,523) = 13.993, p≤0.05, VIF = 1.0) whereas age modestly predicted FAST scores (R2adj = 0.022, F(1,523) = 12.711, p≤0.05, VIF = 1.0). These findings suggest early identification, suitable screening methods and educational intervention programmes should be aimed at all levels of female endurance runners.
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Affiliation(s)
- R A Dervish
- London Sports Institute, Middlesex University, London, NW4 4BT, United Kingdom
| | - L J Wilson
- London Sports Institute, Middlesex University, London, NW4 4BT, United Kingdom
| | - C Curtis
- London Sports Institute, Middlesex University, London, NW4 4BT, United Kingdom
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19
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Dietary Iron and the Elite Dancer. Nutrients 2022; 14:nu14091936. [PMID: 35565904 PMCID: PMC9105128 DOI: 10.3390/nu14091936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 12/10/2022] Open
Abstract
Dancers are an athlete population at high risk of developing iron deficiency (ID). The aesthetic nature of the discipline means dancers potentially utilise dietary restriction to meet physique goals. In combination with high training demands, this means dancers are susceptible to problems related to low energy availability (LEA), which impacts nutrient intake. In the presence of LEA, ID is common because of a reduced mineral content within the low energy diet. Left untreated, ID becomes an issue that results in fatigue, reduced aerobic work capacity, and ultimately, iron deficient anaemia (IDA). Such progression can be detrimental to a dancer’s capacity given the physically demanding nature of training, rehearsal, and performances. Previous literature has focused on the manifestation and treatment of ID primarily in the context of endurance athletes; however, a dance-specific context addressing the interplay between dance training and performance, LEA and ID is essential for practitioners working in this space. By consolidating findings from identified studies of dancers and other relevant athlete groups, this review explores causal factors of ID and potential treatment strategies for dancers to optimise absorption from an oral iron supplementation regime to adequately support health and performance.
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20
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Lundy B, Torstveit MK, Stenqvist TB, Burke LM, Garthe I, Slater GJ, Ritz C, Melin AK. Screening for Low Energy Availability in Male Athletes: Attempted Validation of LEAM-Q. Nutrients 2022; 14:nu14091873. [PMID: 35565840 PMCID: PMC9101736 DOI: 10.3390/nu14091873] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
A questionnaire-based screening tool for male athletes at risk of low energy availability (LEA) could facilitate both research and clinical practice. The present options rely on proxies for LEA such screening tools for disordered eating, exercise dependence, or those validated in female athlete populations. in which the female-specific sections are excluded. To overcome these limitations and support progress in understanding LEA in males, centres in Australia, Norway, Denmark, and Sweden collaborated to develop a screening tool (LEAM-Q) based on clinical investigations of elite and sub-elite male athletes from multiple countries and ethnicities, and a variety of endurance and weight-sensitive sports. A bank of questions was developed from previously validated questionnaires and expert opinion on various clinical markers of LEA in athletic or eating disorder populations, dizziness, thermoregulation, gastrointestinal symptoms, injury, illness, wellbeing, recovery, sleep and sex drive. The validation process covered reliability, content validity, a multivariate analysis of associations between variable responses and clinical markers, and Receiver Operating Characteristics (ROC) curve analysis of variables, with the inclusion threshold being set at 60% sensitivity. Comparison of the scores of the retained questionnaire variables between subjects classified as cases or controls based on clinical markers of LEA revealed an internal consistency and reliability of 0.71. Scores for sleep and thermoregulation were not associated with any clinical marker and were excluded from any further analysis. Of the remaining variables, dizziness, illness, fatigue, and sex drive had sufficient sensitivity to be retained in the questionnaire, but only low sex drive was able to distinguish between LEA cases and controls and was associated with perturbations in key clinical markers and questionnaire responses. In summary, in this large and international cohort, low sex drive was the most effective self-reported symptom in identifying male athletes requiring further clinical assessment for LEA.
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Affiliation(s)
- Bronwen Lundy
- Rowing Australia, Canberra, ACT 2600, Australia;
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Monica K. Torstveit
- Department of Sport Science and Physical Education, Faculty of Health and Sport Science, University of Agder, 4630 Kristiansand, Norway; (M.K.T.); (T.B.S.)
| | - Thomas B. Stenqvist
- Department of Sport Science and Physical Education, Faculty of Health and Sport Science, University of Agder, 4630 Kristiansand, Norway; (M.K.T.); (T.B.S.)
| | - Louise M. Burke
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
- Correspondence:
| | - Ina Garthe
- Norwegian Olympic Sports Centre, Department of Sports Nutrition, 0806 Oslo, Norway;
| | - Gary J. Slater
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia;
| | - Christian Ritz
- National Institute of Public Health—SDU, 1455 Copenhagen, Denmark;
| | - Anna K. Melin
- Department of Sport Science, Faculty of Social Sciences, Linnaeus University, 351 95 Vaxjo, Sweden;
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Xu AL, Beck JJ, Sweeney EA, Severson MN, Page AS, Lee RJ. Understanding the Cheerleader as an Orthopaedic Patient: An Evidence-Based Review of the Literature. Orthop J Sports Med 2022; 10:23259671211067222. [PMID: 35083360 PMCID: PMC8785319 DOI: 10.1177/23259671211067222] [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: 09/01/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
Cheerleading is a highly popular youth sport in the United States and has been increasingly recognized in recent years for its athleticism and competitive nature. The sport has changed dramatically since its inception. When the sport of cheerleading was first developed, its primary purpose was to entertain crowds and support other athletes. Today, cheerleaders are competitive athletes themselves. Cheerleaders, most of whom are in the pediatric age group, and their parents commonly approach orthopaedic surgeons and sports medicine physicians with questions regarding the risks associated with participation in the sport. Appropriate clinical guidance is especially important for athletes returning to the sport after an injury. However, unlike other popular sports (eg, football, basketball, and volleyball), the intricacies of cheerleading are not well-known to those outside the sport, including many health care providers. Previous studies have reported on the epidemiological patterns of injuries associated with cheerleading and how such aesthetic sports affect the body, finding that fractures and concussions are prevalent and that catastrophic injuries are more common than in most other sports. Here, we provide an evidence-based discussion of 10 pertinent topics regarding cheerleading and its risks to the musculoskeletal system. The purpose of this review is to provide a comprehensive resource for orthopaedic surgeons and sports medicine physicians who care for these athletes.
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Affiliation(s)
- Amy L. Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer J. Beck
- Orthopaedic Institute for Children/UCLA, Santa Monica, California, USA
| | - Emily A. Sweeney
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Megan N. Severson
- Carilion Clinic Orthopaedic Surgery, Roanoke, Virginia, USA
- Department of Orthopaedic Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia, USA
| | - A. Stacie Page
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, White Marsh, Maryland, USA
| | - R. Jay Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
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22
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Kinoshita N, Uchiyama E, Ishikawa-Takata K, Yamada Y, Okuyama K. Association of energy availability with resting metabolic rates in competitive female teenage runners: a cross-sectional study. J Int Soc Sports Nutr 2021; 18:70. [PMID: 34784926 PMCID: PMC8594218 DOI: 10.1186/s12970-021-00466-w] [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] [Received: 06/10/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Resting metabolic rate (RMR) has been examined as a proxy for low energy availability (EA). Previous studies have been limited to adult athletes, despite the serious health consequences of low EA, particularly during adolescence. This study aimed to explore the relationship between RMR and EA in competitive teenage girl runners. Methods Eighteen girl runners (mean ± standard-deviation; age, 16.8 ± 0.9 years; body mass, 45.6 ± 5.2 kg, %fat, 13.5 ± 4.2 %) in the same competitive high-school team were evaluated. Each runner was asked to report dietary records with photos and training logs for seven days. Energy intake (EI) was assessed by Registered Dietitian Nutritionists. The runners were evaluated on a treadmill with an indirect calorimeter to yield individual prediction equations for oxygen consumption using running velocity and heart rate (HR). Exercise energy expenditure (EEE) was calculated by the equations based on training logs and HR. Daily EA was calculated by subtracting EEE from EI. The daily means of these variables were calculated. RMR was measured early in the morning by whole-room calorimetry after overnight sleep on concluding the final day of the seven-day assessment. The ratio of measured RMR to predicted RMR (RMR ratio) was calculated by race, age, sex-specific formulae, and Cunningham’s equation. Body composition was measured using dual-energy X-ray absorptiometry. Bivariate correlation analyses were used to examine the relationship between variables. Results RMR, EI, EEE, and EA were 26.9 ± 2.4, 56.8 ± 15.2, 21.7 ± 5.9, and 35.0 ± 15.0 kcal⋅kg−1 FFM⋅d−1, respectively. RMR reduced linearly with statistical significance, while EA decreased to a threshold level (30 kcal⋅kg−1 FFM⋅d−1) (r= 0.58, p= 0.048). Further reduction in RMR was not observed when EA fell below the threshold. There was no significant correlation between RMR ratios and EA, irrespective of the prediction formulae used. Conclusions These results suggest that RMR does not reduce with a decrease in EA among highly competitive and lean teenage girl runners. RMR remains disproportionally higher than expected in low EA states. Free-living teenage girl runners with low EA should be cautiously identified using RMR as a proxy for EA change.
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Affiliation(s)
- Norimitsu Kinoshita
- Faculty of Sports and Health Studies, Hosei University, 4342 Aihara, Tokyo, 194-0298, Machida, Japan.
| | - Eriko Uchiyama
- Faculty of Sports and Health Studies, Hosei University, 4342 Aihara, Tokyo, 194-0298, Machida, Japan
| | - Kazuko Ishikawa-Takata
- Health and Nutrition, National Institutes of Biomedical Innovation, 1-23-1 Toyama, Tokyo, 162-8636, Shinjuku, Japan.,Faculty of Applied Bioscience, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Tokyo, 156-8502, Setagaya, Japan
| | - Yuka Yamada
- Health and Nutrition, National Institutes of Biomedical Innovation, 1-23-1 Toyama, Tokyo, 162-8636, Shinjuku, Japan
| | - Kenta Okuyama
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms Gata 35, 20502, Malmö, Sweden
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23
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Wang J, Guan H, Hostrup M, Rowlands DS, González-Alonso J, Jensen J. The Road to the Beijing Winter Olympics and Beyond: Opinions and Perspectives on Physiology and Innovation in Winter Sport. JOURNAL OF SCIENCE IN SPORT AND EXERCISE 2021; 3:321-331. [PMID: 36304069 PMCID: PMC8475427 DOI: 10.1007/s42978-021-00133-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022]
Abstract
Beijing will host the 2022 Winter Olympics, and China strengthens research on various aspects to allow their athletes to compete successfully in winter sport. Simultaneously, Government-directed initiatives aim to increase public participation in recreational winter sport. These parallel developments allow research to advance knowledge and understanding of the physiological determinants of performance and health related to winter sport. Winter sport athletes often conduct a substantial amount of training with high volumes of low-to-moderate exercise intensity and lower volumes of high-intensity work. Moreover, much of the training occur at low ambient temperatures and winter sport athletes have high risk of developing asthma or asthma-related conditions, such as exercise-induced bronchoconstriction. The high training volumes require optimal nutrition with increased energy and dietary protein requirement to stimulate muscle protein synthesis response in the post-exercise period. Whether higher protein intake is required in the cold should be investigated. Cross-country skiing is performed mostly in Northern hemisphere with a strong cultural heritage and sporting tradition. It is expected that innovative initiatives on recruitment and training during the next few years will target to enhance performance of Chinese athletes in classical endurance-based winter sport. The innovation potential coupled with resourcing and population may be substantial with the potential for China to become a significant winter sport nation. This paper discusses the physiological aspects of endurance training and performance in winter sport highlighting areas where innovation may advance in athletic performance in cold environments. In addition, to ensure sustainable development of snow sport, a quality ski patrol and rescue system is recommended for the safety of increasing mass participation.
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Affiliation(s)
- Jun Wang
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
| | - Hongwei Guan
- Department of Health Promotion and Physical Education, School of Health Sciences and Human Performance, Ithaca College, Ithaca, NY 14850 USA
| | - Morten Hostrup
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - David S. Rowlands
- School of Sport, Exercise, and Nutrition, College of Health, Massey University, Auckland, New Zealand
| | - José González-Alonso
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, UK
| | - Jørgen Jensen
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
- Department of Physical Performance, Norwegian School of Sport Sciences, Ullevål Stadion, P.O.Box 4012, 0806 Oslo, Norway
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24
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Katharina W, Mohamad M, Derrick T, Martina G, Gerold W, Claus L, Lee H, Thomas R, Beat K. Supplement intake in half-marathon, (ultra-)marathon and 10-km runners - results from the NURMI study (Step 2). J Int Soc Sports Nutr 2021; 18:64. [PMID: 34579746 PMCID: PMC8477506 DOI: 10.1186/s12970-021-00460-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 09/06/2021] [Indexed: 12/13/2022] Open
Abstract
The primary nutritional challenge facing endurance runners is meeting the nutrient requirements necessary to optimize the performance and recovery of prolonged training sessions. Supplement intake is a commonly used strategy by elite and recreational distance runners to meet nutritional recommendations. This study was conducted to investigate the patterns of supplement intake among different groups of distance runners and the potential association between supplement intake and sex, age, running and racing experiences.In a cross-sectional design, from a total of 317 runners participating in this survey, 119 distance runners were involved in the final sample after data clearance, assigned into three groups of 10-km runners (n = 24), half-marathoners (n = 44), and (ultra-)marathoners (n = 51). Personal characteristics, training and racing experiences, as well as patterns of supplement intake, including type, frequency, and dosage, were evaluated by questionnaire. Food Frequency Questionnaire was implemented to assess macronutrient intake. ANOVA and logistic regression were used for statistical analysis.While 50 % of total distance runners reported consuming supplements regularly, no differences between distance groups in consumption of carbohydrate/protein, mineral, or vitamin supplements were observed (p > 0.05). In addition, age, sex, running and racing experience showed no significant association with supplement intake (p > 0.05). Vitamin supplements had the highest intake rate in runners by 43 % compared to minerals (34 %) and carbohydrate/protein supplements (19 %).The present findings provide a window into the targeted approaches of long-distance runners as well as their coaches and sport nutrition specialists when applying and suggesting sustainable nutritional strategies for training and competition.Trial registration: ISRCTN73074080. Retrospectively registered 12th June 2015.
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Affiliation(s)
- Wirnitzer Katharina
- Department of Subject Didactics and Educational Research and Development, University College of Teacher Education Tyrol, Innsbruck, Austria
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Life and Health Science Cluster Tirol, Subcluster Health/Medicine/Psychology, Innsbruck, Austria
- Research Center Medical Humanities, Leopold-Franzens University of Innsbruck, Innsbruck, Austria
| | - Motevalli Mohamad
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Faculty of Physical Education and Sports Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Tanous Derrick
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Gregori Martina
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | | | - Leitzmann Claus
- Institute of Nutrition, University of Gießen, Gießen, Germany
| | - Hill Lee
- Divison of Gastroenterology and Nutrition, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Rosemann Thomas
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Knechtle Beat
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
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25
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Holtzman B, Ackerman KE. Recommendations and Nutritional Considerations for Female Athletes: Health and Performance. Sports Med 2021; 51:43-57. [PMID: 34515972 PMCID: PMC8566643 DOI: 10.1007/s40279-021-01508-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
Optimal nutrition is an important aspect of an athlete’s preparation to achieve optimal health and performance. While general concepts about micro- and macronutrients and timing of food and fluids are addressed in sports science, rarely are the specific effects of women’s physiology on energy and fluid needs highly considered in research or clinical practice. Women differ from men not only in size, but in body composition and hormonal milieu, and also differ from one another. Their monthly hormonal cycles, with fluctuations in estrogen and progesterone, have varying effects on metabolism and fluid retention. Such cycles can change from month to month, can be suppressed with exogenous hormones, and may even be manipulated to capitalize on ideal timing for performance. But before such physiology can be manipulated, its relationship with nutrition and performance must be understood. This review will address general concepts regarding substrate metabolism in women versus men, common menstrual patterns of female athletes, nutrient and hydration needs during different phases of the menstrual cycle, and health and performance issues related to menstrual cycle disruption. We will discuss up-to-date recommendations for fueling female athletes, describe areas that require further exploration, and address methodological considerations to inform future work in this important area.
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Affiliation(s)
- Bryan Holtzman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Kathryn E Ackerman
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA. .,Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Supplement Intake in Recreational Vegan, Vegetarian, and Omnivorous Endurance Runners-Results from the NURMI Study (Step 2). Nutrients 2021; 13:nu13082741. [PMID: 34444901 PMCID: PMC8399632 DOI: 10.3390/nu13082741] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/14/2022] Open
Abstract
Nutrient deficiency is a common cause of underperformance in endurance athletes, and supplement intake is frequently considered compensatory for vegan and vegetarian athletes specifically. This study aimed to investigate the patterns of supplement intake among vegan, vegetarian, and omnivorous distance (>10 km) runners and its association with age, sex, and race distance. From a total of 317 runners who participated in an online survey, 220 distance runners (mean age: 38.5 years; mean BMI: 21.75 kg/m2) were selected for the final sample after data clearance and assigned to 100 omnivores, 40 vegetarians, or 80 vegans. Sociodemographic information, racing experience, and patterns of supplement intake, including type, frequency, dosage, etc., were collected using a questionnaire. Macronutrient intake was assessed using a food frequency questionnaire. ANOVA and logistic regression were used for data analysis. The prevalence of supplement intake was 51% for total runners and 72% among vegan runners. Age, sex, and race distance had no significant effect on the type of supplement intake (p > 0.05). Compared to omnivores and vegetarians, vegan runners reported consuming more vitamin (but not carbohydrate/protein or mineral) supplements (p < 0.05). Vitamin B12, magnesium, and multivitamin had the most prevalent use amongst micronutrient supplements. This study points to a central role for supplementary nutritional strategies in different groups of distance runners. The present findings may help future investigations by design to identify specific requirements of endurance runners when adhering to specific kinds of diet particularly plant-based diets.
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27
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Potential Low Energy Availability (LEA) Risk Amongst Amateur and Recreational Athletes in Singapore. PHYSICAL ACTIVITY AND HEALTH 2021. [DOI: 10.5334/paah.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Chandran A, Roby PR, Boltz AJ, Robison HJ, Morris SN, Collins CL. Epidemiology of Injuries in National Collegiate Athletic Association Women's Gymnastics: 2014-2015 Through 2018-2019. J Athl Train 2021; 56:688-694. [PMID: 34280287 DOI: 10.4085/1062-6050-635-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Women's gymnastics athletes in the National Collegiate Athletic Association (NCAA) constitute a unique population of NCAA athletes given the nature and dynamics of the sport. BACKGROUND Routine examination of women's gymnastics injuries is important for identifying the evolving burden of injuries in this sport. METHODS Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics; injury rate ratios were used to examine differential injury rates. RESULTS The overall injury rate was 8.00 per 1000 athlete-exposures; injury incidence was greater in competitions than in practices (injury rate ratio = 1.84; 95% CI = 1.48, 2.29), though practice injury rates increased during 2015-2016 through 2018-2019. Most injuries were classified as strains (16.5%), sprains (16.4%), and inflammatory conditions (12.3%), with overuse injuries prevalent among practice injuries (22.5%). Concussions (8.4%) were the most commonly reported specific injury. SUMMARY The increasing trend in practice injury incidence is noteworthy although competition injury rates were higher overall. Findings also suggest that the etiologies of overuse injuries and inflammatory conditions as well as the biomechanical aspects of concussions warrant further attention.
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Affiliation(s)
- Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Patricia R Roby
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA
| | - Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Hannah J Robison
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Sarah N Morris
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
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29
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Kuikman MA, Mountjoy M, Burr JF. Examining the Relationship between Exercise Dependence, Disordered Eating, and Low Energy Availability. Nutrients 2021; 13:2601. [PMID: 34444761 PMCID: PMC8398044 DOI: 10.3390/nu13082601] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 12/18/2022] Open
Abstract
Both dietary and exercise behaviors need to be considered when examining underlying causes of low energy availability (LEA). The study assessed if exercise dependence is independently related to the risk of LEA with consideration of disordered eating and athlete calibre. Via survey response, female (n = 642) and male (n = 257) athletes were categorized by risk of: disordered eating, exercise dependence, disordered eating and exercise dependence, or if not presenting with disordered eating or exercise dependence as controls. Compared to female controls, the likelihood of being at risk of LEA was 2.5 times for female athletes with disordered eating and >5.5 times with combined disordered eating and exercise dependence. Male athletes with disordered eating, with or without exercise dependence, were more likely to report signs and symptoms compared to male controls-including suppression of morning erections (OR = 3.4; p < 0.0001), increased gas and bloating (OR = 4.0-5.2; p < 0.002) and were more likely to report a previous bone stress fracture (OR = 2.4; p = 0.01) and ≥22 missed training days due to overload injuries (OR = 5.7; p = 0.02). For both males and females, in the absence of disordered eating, athletes with exercise dependence were not at an increased risk of LEA or associated health outcomes. Compared to recreational athletes, female and male international caliber and male national calibre athletes were less likely to be classified with disordered eating.
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Affiliation(s)
- Megan A. Kuikman
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Margo Mountjoy
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8P 1H6, Canada;
| | - Jamie F. Burr
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada;
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Stellingwerff T, Heikura IA, Meeusen R, Bermon S, Seiler S, Mountjoy ML, Burke LM. Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): Shared Pathways, Symptoms and Complexities. Sports Med 2021; 51:2251-2280. [PMID: 34181189 DOI: 10.1007/s40279-021-01491-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/14/2022]
Abstract
The symptom similarities between training-overload (with or without an Overtraining Syndrome (OTS) diagnosis) and Relative Energy Deficiency in Sport (RED-S) are significant, with both initiating from a hypothalamic-pituitary origin, that can be influenced by low carbohydrate (CHO) and energy availability (EA). In this narrative review we wish to showcase that many of the negative outcomes of training-overload (with, or without an OTS diagnosis) may be primarily due to misdiagnosed under-fueling, or RED-S, via low EA and/or low CHO availability. Accordingly, we undertook an analysis of training-overload/OTS type studies that have also collected and analyzed for energy intake (EI), CHO, exercise energy expenditure (EEE) and/or EA. Eighteen of the 21 studies (86%) that met our criteria showed indications of an EA decrease or difference between two cohorts within a given study (n = 14 studies) or CHO availability decrease (n = 4 studies) during the training-overload/OTS period, resulting in both training-overload/OTS and RED-S symptom outcomes compared to control conditions. Furthermore, we demonstrate significantly similar symptom overlaps across much of the OTS (n = 57 studies) and RED-S/Female Athlete Triad (n = 88 studies) literature. It is important to note that the prevention of under-recovery is multi-factorial, but many aspects are based around EA and CHO availability. Herein we have demonstrated that OTS and RED-S have many shared pathways, symptoms, and diagnostic complexities. Substantial attention is required to increase the knowledge and awareness of RED-S, and to enhance the diagnostic accuracy of both OTS and RED-S, to allow clinicians to more accurately exclude LEA/RED-S from OTS diagnoses.
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Affiliation(s)
- Trent Stellingwerff
- Pacific Institute for Sport Excellence, Canadian Sport Institute-Pacific, 4371 Interurban Road, Victoria, BC, V9E 2C5, Canada.
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada.
| | - Ida A Heikura
- Pacific Institute for Sport Excellence, Canadian Sport Institute-Pacific, 4371 Interurban Road, Victoria, BC, V9E 2C5, Canada
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stéphane Bermon
- Université Côte d'Azur, LAMHESS Nice, Nice, France
- World Athletics, Health and Science Department, Monte Carlo, Monaco
| | - Stephen Seiler
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Margo L Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- IOC Medical Commission Games Group, Lausanne, Switzerland
| | - Louise M Burke
- Australian Institute of Sport, Bruce, ACT, Australia
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
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31
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Villa M, Villa-Vicente JG, Seco-Calvo J, Mielgo-Ayuso J, Collado PS. Body Composition, Dietary Intake and the Risk of Low Energy Availability in Elite-Level Competitive Rhythmic Gymnasts. Nutrients 2021; 13:nu13062083. [PMID: 34207034 PMCID: PMC8233987 DOI: 10.3390/nu13062083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to analyze dietary intake and body composition in a group of elite-level competitive rhythmic gymnasts from Spain. We undertook body composition and nutritional analysis of 30 elite gymnasts, divided into two groups by age: pre-teen (9-12 years) (n = 17) and teen (13-18 years) (n = 13). Measures of height, weight, and bioimpedance were used to calculate body mass index and percent body fat. Energy and nutrient intakes were assessed based on 7-day food records. The two groups had similar percentages of total body fat (pre-teen: 13.99 ± 3.83% vs. teen: 14.33 ± 5.57%; p > 0.05). The energy availability values for pre-teens were above the recommended values (>40 kcal/FFM/day) 69.38 ± 14.47 kcal/FFM/day, while those for the teens were much lower (34.7 ± 7.5 kcal/FFM/day). The distribution of the daily energy intake across the macronutrients indicates that both groups ingested less than the recommended level of carbohydrates and more than the recommended level of fat. Very low intakes of calcium and vitamin D among other micronutrients were also noted. The main finding is that teenage gymnasts do not consume as much energy as they need each day, which explains their weight and development. Moreover, they are at a high risk of developing low energy availability that could negatively impact their performance and future health.
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Affiliation(s)
- María Villa
- Department of Health Sciences, Faculty of Health Sciences, University Pontificia of Salamanca, 37002 Salamanca, Spain;
| | - José G. Villa-Vicente
- Institute of Biomedicine (IBIOMED), University of Leon, 24071 Leon, Spain; (J.G.V.-V.); (P.S.C.)
| | - Jesus Seco-Calvo
- Institute of Biomedicine (IBIOMED), University of Leon, 24071 Leon, Spain; (J.G.V.-V.); (P.S.C.)
- Department of Physiology, University of the Basque Country, 48940 Leioa, Spain
- Correspondence: or ; Tel.: +34-987-293-127
| | - Juan Mielgo-Ayuso
- Department of Health Sciences, Faculty of Health Sciences, University of Burgos, 09001 Burgos, Spain;
| | - Pilar S. Collado
- Institute of Biomedicine (IBIOMED), University of Leon, 24071 Leon, Spain; (J.G.V.-V.); (P.S.C.)
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32
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Maria UPD, Juzwiak CR. CULTURAL ADAPTATION AND VALIDATION OF THE LOW ENERGY AVAILABILITY IN FEMALES QUESTIONNAIRE (LEAF-Q). REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-869220212702223889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
ABSTRACT Introduction: Low energy availability, amenorrhea and osteoporosis make up the Female Athlete Triad observed in physically active females and athletes. The Low Energy Availability in Females Questionnaire (LEAF-Q) was created with the purpose of identifying female athletes at risk for the Female Athlete Triad. Objective: To translate and culturally adapt the LEAF-Q for Brazilian Portuguese and validate it in a group of Brazilian athletes. Methods: The first stage of the study consisted of translation, cultural adaptation and content validation of the questionnaire in 20 athletes. In the second stage, for the test-retest reliability analysis and the construct validation, the final adapted version was applied in a sample of 127 athletes from various sports disciplines, 54 of whom responded to the questionnaire on a second occasion. For the test-retest reliability analysis, the intraclass correlation coefficient (ICC) was calculated and the paired t-test, McNemar’s test and Bland-Altman plot were carried out. The construct validation modeled by known or contrasted groups was carried out by comparing the mean LEAF-Q scores of group 1 (athletes who practiced weight-sensitive sports) with those of group 2 (athletes who practiced team sports) using the Student’s t test. Results: The Brazilian version of the LEAF-Q showed excellent test-retest reliability, with an ICC of 0.92. The construct validity by known or contrasted groups was confirmed after demonstrating that athletes who practiced weight-sensitive sports had a higher LEAF-Q mean score than athletes who practiced team sports (p≤0.05). Conclusion: The Brazilian version of the LEAF-Q is an important tool, which presented textual and cultural adequacy, proved to be reliable in terms of test-retest reliability, and presents evidence of validity to investigate the risk of the triad. Level of evidence II; Diagnostic Studies – Investigating a diagnostic instrument .
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Risk of Low Energy Availability among Female and Male Elite Runners Competing at the 26th European Cross-Country Championships. Nutrients 2021; 13:nu13030873. [PMID: 33800051 PMCID: PMC8000897 DOI: 10.3390/nu13030873] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 03/03/2021] [Indexed: 02/08/2023] Open
Abstract
Low energy availability (LEA) causes impaired physiological functioning. Cross-country running is a weight-sensitive sport, making athletes more prone to LEA. We aimed to estimate the prevalence of elite European cross-country athletes at risk of LEA using the LEA in Females Questionnaire (LEAF-Q) and to analyze demographic and physical characteristics that are associated with LEA. Athletes ≥ 18 years competing at the 26th European Cross-Country Championships (n = 602) were invited to complete a questionnaire (sociodemographic, training, anthropometric characteristics, and LEAF-Q). A total of 207 valid surveys were collected (83 females, 22.1 (4.0) years, and 124 males, 22.3 (4.1) years), and 16 surveys were excluded. A high prevalence of athletes at risk of LEA (64.3%) was observed, being higher in females than in males (79.5 and 54.0% respectively, p < 0.001). More than half of athletes (54.1%, n = 112) reported bowel movements once a week or more rarely, while 33 female athletes (41.3%) did not report normal menstruation. Overall, cross-country athletes are at high risk of LEA. Moreover, a high prevalence of gastrointestinal and menstrual impairments was reported. Hence, athletes should be followed by multidisciplinary teams to inform, prevent, and treat LEA and its effects.
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