scholarly journals Female football specific energy availability questionnaire and menstrual cycle hormone monitoring

2021 ◽  
Author(s):  
Nicola Keay ◽  
Eddie Craghill ◽  
Gavin Francis
Keyword(s):  
Menstrual Cycle ◽  
Female Athletes ◽  
Previous History ◽  
Relative Energy ◽  
Training Load ◽  
Low Risk ◽  
Energy Availability ◽  
Clinical Tool ◽  
Variable Flow ◽  
Energy Deficiency

Abstract Objectives The purpose of this study was to assess the energy availability status of professional female football players with an online Female Football Energy Availability Questionnaire (FFEAQ), combined with the clinical tool to model menstrual cycle hormones using artificial intelligence (AI) techniques. Methods The Female Football Energy Availability (FFEAQ) was developed based on published questionnaires, with a weighted scoring system to assess risk of Relative Energy Deficiency in Sport (RED-S). For menstrual cycle hormones AI techniques modelled hormone variation over a cycle, using the results from capillary blood samples taken at two time points. Results 21 female footballers of professional club level participated in this study, with mean age 22 years [range 16 to 30]. 20 athletes recorded positive scores on the FFEAQ, suggesting a low risk of Relative Energy Deficiency in Sport (RED-S). No players had experienced primary amenorrhoea. 5 athletes reported previous history of secondary amenorrhoea. Amongst the 15 players not taking hormonal contraception, 2 reported current oligomenorrhoea. The application of AI techniques to model menstrual cycle hormones found that in 1 of the 3 players, subclinical hormone disruption was occurring with this player reporting variable flow of menstruation. Although the other 2 players showed expected menstrual hormone variation, 1 player reported variable flow according to training load, suggestive of subclinical anovulation. At the time of testing training load was low due to pandemic lock down. Conclusions The professional female football athletes in this study were found to be at low risk of RED-S from the FFEAQ. Modelling menstrual cycle hormones using AI techniques indicated that this has the potential to be an effective clinical tool in identifying subtle hormone dysfunction such as subclinical anovulatory cycles in female athletes.

Low energy availability surrogates correlate with health and performance consequences of Relative Energy Deficiency in Sport

2018 ◽  
Vol 53 (10) ◽  
pp. 628-633 ◽  
Author(s):  
Kathryn E Ackerman ◽  
Bryan Holtzman ◽  
Katherine M Cooper ◽  
Erin F Flynn ◽  
Georgie Bruinvels ◽  
...  
Keyword(s):  
Female Athletes ◽  
Relative Energy ◽  
Low Energy ◽  
Clinical Population ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Increased Risk ◽  
Performance Consequences ◽  
And Performance ◽  
Low Energy Availability

Low energy availability (EA) is suspected to be the underlying cause of both the Female Athlete Triad and the more recently defined syndrome, Relative Energy Deficiency in Sport (RED-S). The International Olympic Committee (IOC) defined RED-S as a syndrome of health and performance impairments resulting from an energy deficit. While the importance of adequate EA is generally accepted, few studies have attempted to understand whether low EA is associated with the health and performance consequences posited by the IOC.ObjectiveThe purpose of this cross-sectional study was to examine the association of low EA with RED-S health and performance consequences in a large clinical population of female athletes.MethodsOne thousand female athletes (15–30 years) completed an online questionnaire and were classified as having low or adequate EA. The associations between low EA and the health and performance factors listed in the RED-S models were evaluated using chi-squared test and the odds ratios were evaluated using binomial logistic regression (p<0.05).ResultsAthletes with low EA were more likely to be classified as having increased risk of menstrual dysfunction, poor bone health, metabolic issues, haematological detriments, psychological disorders, cardiovascular impairment and gastrointestinal dysfunction than those with adequate EA. Performance variables associated with low EA included decreased training response, impaired judgement, decreased coordination, decreased concentration, irritability, depression and decreased endurance performance.ConclusionThese findings demonstrate that low EA measured using self-report questionnaires is strongly associated with many health and performance consequences proposed by the RED-S models.

Clinical application of interactive monitoring of indicators of health in professional dancers (Preprint)

2021 ◽  
Author(s):  
Nicola Keay ◽  
Martin Lanfear ◽  
Gavin Francis
Keyword(s):  
At Risk ◽  
Early Identification ◽  
Hormonal Contraception ◽  
Well Being ◽  
Relative Energy ◽  
Low Risk ◽  
Energy Availability ◽  
Health Questionnaire ◽  
Blood Testing ◽  
Energy Deficiency

BACKGROUND Dancers can be at risk of developing intentional and/or unintentional relative energy deficiency in sport (RED-S). Early identification of those at risk is important in prevention. OBJECTIVE The purpose of this study was to assess the effectiveness of interactive monitoring of professional dancer health with a variety of subjective and objective monitoring methods and delivering swift personalised clinical advice. METHODS Dancers from a ballet company completed a published, online dance-specific health questionnaire. Over the study period, dancers recorded wellbeing and training metrics, with menstrual cycle tracking and capillary blood testing for the recognised indicators of low energy availability. At regular, virtual clinical discussions with each dancer, findings were discussed and personalised advice given. RESULTS Twenty dancers participated in the study (mean age 26.2 years, SD 3.7), comprising 14 females (mean age 25.5 years, SD 3.7) and 6 males (mean age 27.7 years, SD 2.4). Ten of the female and all the male dancers recorded positive scores on the dance health questionnaire, suggesting a low risk of relative energy deficiency in sport (RED-S). Two female dancers were taking hormonal contraception. Apart from one, all female dancers not on hormonal contraception reported current eumenorrhoeic status. Blood testing confirmed the low risk of insufficient energy availability across the group, apart from female dancers with negative questionnaire scores. The initiative of monitoring menstrual cycles and on demand virtual clinical support was well received by dancers, healthcare and artistic staff. CONCLUSIONS Multimodal monitoring facilitated delivery of prompt personalised clinical medical feedback specific for dance. This interactive strategy permitted the early identification and swift management of emergent clinical issues. Dancers highly rated the new monitoring modalities and opportunity to discuss health and well-being, in confidence, with a doctor conversant in dance.

Prevalence of impaired physiological function consistent with Relative Energy Deficiency in Sport (RED-S): an Australian elite and pre-elite cohort

2020 ◽  
Vol 55 (1) ◽  
pp. 38-45
Author(s):  
Margot Anne Rogers ◽  
Renee Newcomer Appaneal ◽  
David Hughes ◽  
Nicole Vlahovich ◽  
Gordon Waddington ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Female Athletes ◽  
Relative Energy ◽  
Low Energy ◽  
Point Prevalence ◽  
Energy Availability ◽  
Mineral Density ◽  
Energy Deficiency ◽  
S Model ◽  
Low Energy Availability

ObjectivesAthlete health, training continuity and performance can be impeded as a result of Relative Energy Deficiency in Sport (RED-S). Here we report the point prevalence of symptoms described by the RED-S model in a mixed-sport cohort of Australian female athletes.MethodsElite and pre-elite female athletes (n=112) from eight sports completed validated questionnaires and underwent clinical assessment to assess the point prevalence of RED-S symptoms. Questionnaires included the Depression, Anxiety and Stress Questionnaire (DASS-21), Generalized Anxiety Disorder (GAD-7), Center for Epidemiological Studies Depression Scale (CES-D), SCOFF questionnaire for disordered eating, Low Energy Availability in Females Questionnaire (LEAF-Q), and a custom questionnaire on injury and illness. Clinical assessment comprised resting metabolic rate (RMR) assessment, dual-energy X-ray absorptiometry-derived body composition and bone mineral density, venous and capillary blood samples, and the Mini International Neuropsychiatric Interview (MINI 7.0.2). Descriptive prevalence statistics are presented.ResultsAlmost all (80%) participants (age 19 (range 15–32) years; mass 69.5±10.3 kg; body fat 23.1%±5.0%) demonstrated at least one symptom consistent with RED-S, with 37% exhibiting between two and three symptoms. One participant demonstrated five symptoms. Impaired function of the immunological (28%, n=27), haematological (31%, n=33) and gastrointestinal (47%, n=51) systems were most prevalent. A moderate to high (11%–55%) prevalence of risk of low energy availability was identified via RMR and LEAF-Q, and identified mental illnesses were prevalent in one-third of the assessed cohort.ConclusionSymptoms described by the RED-S model were prevalent in this cohort, supporting the need for improved awareness, monitoring and management of these symptoms in this population.

scholarly journals Clinical application of interactive monitoring of indicators of health in professional dancers

2021 ◽  
Author(s):  
Nicola Keay ◽  
Martin Lanfear ◽  
Gavin Francis
Keyword(s):  
Hormonal Contraception ◽  
Well Being ◽  
Relative Energy ◽  
Low Risk ◽  
Energy Availability ◽  
Health Questionnaire ◽  
Monitoring Methods ◽  
Blood Testing ◽  
Energy Deficiency ◽  
Professional Dancer

Abstract Objectives The purpose of this study was to assess the effectiveness of interactive monitoring of professional dancer health with a variety of subjective and objective monitoring methods and delivering swift personalised clinical advice. Methods Dancers from a ballet company completed a published, online dance-specific health questionnaire. Over the study period, dancers recorded wellbeing and training metrics, with menstrual cycle tracking and capillary blood testing for the recognised indicators of low energy availability. At regular, virtual clinical discussions with each dancer, findings were discussed and personalised advice given. Results Twenty dancers participated in the study (mean age 26.2 years, SD 3.7), comprising 14 females (mean age 25.5 years, SD 3.7) and 6 males (mean age 27.7 years, SD 2.4). Ten of the female and all the male dancers recorded positive scores on the dance health questionnaire, suggesting a low risk of relative energy deficiency in sport (RED-S). Two female dancers were taking hormonal contraception. Apart from one, all female dancers not on hormonal contraception reported current eumenorrhoeic status. Blood testing confirmed the low risk of insufficient energy availability across the group, apart from female dancers with negative questionnaire scores. The initiative of monitoring menstrual cycles and on demand virtual clinical support was well received by dancers, healthcare and artistic staff. Conclusions Multimodal monitoring facilitated delivery of prompt personalised clinical medical feedback specific for dance. This interactive strategy permitted the early identification and swift management of emergent clinical issues. Dancers highly rated the new monitoring modalities and opportunity to discuss health and well-being, in confidence, with a doctor conversant in dance.

scholarly journals A Review of Prevention, Diagnosis, and Treatment of Relative Energy Deficiency in Sport in Artistic (Synchronized) Swimming

2018 ◽  
Vol 28 (4) ◽  
pp. 375-384 ◽  
Author(s):  
Sherry Robertson ◽  
Margo Mountjoy
Keyword(s):  
Dietary Habits ◽  
Female Athletes ◽  
Assessment Tool ◽  
Relative Energy ◽  
Low Energy ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Synchronized Swimming ◽  
And Performance ◽  
Low Energy Availability

The syndrome of relative energy deficiency in sport (RED-S) is a clinical entity characterized by low energy availability, which can negatively affect the health and performance of both male and female athletes. The underlying mechanism of RED-S is an inadequacy of dietary energy to support optimal health and performance. This syndrome refers to impaired physiological function, including metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health, with psychological consequences that can either precede (through restrictive dietary habits) or result from RED-S. The term RED-S extends beyond the condition termed the “Female Athlete Triad.” Formerly known as synchronized swimming, artistic swimming is an Olympic sport requiring a high level of fitness as well as technical skill and artistry. The risk of RED-S is high in artistic swimming as it is an aesthetic, judged sport with an emphasis on a lean physique. RED-S is of significant concern in the sport of artistic swimming because of the potential negative effects on physical and mental health as well as consequences on athletic performance. This paper reviews health and performance consequences associated with low energy availability resulting in RED-S in artistic swimming. Medical and nutritional considerations specific to artistic swimming are reviewed, and methods to help detect and manage RED-S are discussed. Prevention and management of RED-S in this athlete population should be a priority for coaches, and the sport medicine professionals working with artistic swimming athletes should utilize the RED-S CAT, a Clinical Assessment Tool for screening and managing RED-S.

A Review of Nonpharmacological Strategies in the Treatment of Relative Energy Deficiency in Sport

2020 ◽  
pp. 1-8
Author(s):  
Megan A. Kuikman ◽  
Margo Mountjoy ◽  
Trent Stellingwerff ◽  
Jamie F. Burr
Keyword(s):  
Energy Expenditure ◽  
Energy Intake ◽  
Female Athletes ◽  
Relative Energy ◽  
Performance Outcomes ◽  
Fat Free Mass ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Exercise Energy Expenditure ◽  
And Performance

Relative energy deficiency in sport (RED-S) can result in negative health and performance outcomes in both male and female athletes. The underlying etiology of RED-S is low energy availability (LEA), which occurs when there is insufficient dietary energy intake to meet exercise energy expenditure, corrected for fat-free mass, leaving inadequate energy available to ensure homeostasis and adequate energy turnover (optimize normal bodily functions to positively impact health), but also optimizing recovery, training adaptations, and performance. As such, treatment of RED-S involves increasing energy intake and/or decreasing exercise energy expenditure to address the underlying LEA. Clinically, however, the time burden and methodological errors associated with the quantification of energy intake, exercise energy expenditure, and fat-free mass to assess energy availability in free-living conditions make it difficult for the practitioner to implement in everyday practice. Furthermore, interpretation is complicated by the lack of validated energy availability thresholds, which can result in compromised health and performance outcomes in male and female athletes across various stages of maturation, ethnic races, and different types of sports. This narrative review focuses on pragmatic nonpharmacological strategies in the treatment of RED-S, featuring factors such as low carbohydrate availability, within-day prolonged periods of LEA, insufficient intake of bone-building nutrients, lack of mechanical bone stress, and/or psychogenic stress. This includes the implementation of strategies that address exacerbating factors of LEA, as well as novel treatment methods and underlying mechanisms of action, while highlighting areas of further research.

scholarly journals Knowledge of Low Energy Availability, Relative Energy Deficiency in Sport and the Female Athlete Triad Amongst Female Athletes and Active Individuals

Proceedings ◽  
2019 ◽  
Vol 37 (1) ◽  
pp. 24
Author(s):  
Winter ◽  
Black ◽  
Brown
Keyword(s):  
Female Athlete ◽  
Female Athletes ◽  
Relative Energy ◽  
Low Energy ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Energy Deficiency ◽  
Exercise Energy Expenditure ◽  
Low Energy Availability ◽  
Normal Physiological Function

Background: Low Energy Availability (LEA), Relative Energy Deficiency in Sport (RED-S) and the Female Athlete Triad (Triad) are generally related to the negative health effects of consuming insufficient energy to meet exercise energy expenditure and maintain normal physiological function. [...]

scholarly journals URINARY INCONTINENCE IS MORE COMMON IN ADOLESCENT FEMALE ATHLETES WITH LOW ENERGY AVAILABILITY

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0011
Author(s):  
Kristin E. Whitney ◽  
Bryan Holtzman ◽  
Allyson Parziale ◽  
Kathryn E. Ackerman
Keyword(s):  
Urinary Incontinence ◽  
Eating Disorder ◽  
Female Athlete ◽  
Female Athletes ◽  
Relative Energy ◽  
Low Energy ◽  
Adolescent Female ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Low Energy Availability

BACKGROUND: Female Athlete Triad (Triad), an interrelated syndrome of low energy availability (EA), menstrual irregularity, and low bone mineral density. A broader, more comprehensive term was recently introduced by the International Olympic Committee: ‘Relative Energy Deficiency in Sport’ (RED-S). RED-S includes Triad, but also highlights the multiplicity of complex health and performance consequences of low EA and emphasizes that male athletes are also affected. The syndrome RED-S refers to impaired physiological function caused by relative energy deficiency including menstrual function, metabolism, bone health, immunity, protein synthesis, and cardiovascular health. Low EA has independent negative effects on reproductive function and gonadal steroid production. Urinary incontinence (UI) has many risk factors, including estrogen deficiency (which can be caused by low EA), depression, and participation in high-impact activities. A high prevalence of UI has been reported in female athletes participating in a variety of different sports. To date, research evaluating low energy availability as an independent risk factor for UI has been limited, particularly in a young female athlete population. The purpose of this study was to evaluate the association of UI and low EA in adolescent female athletes. METHODS: 1000 female athletes (ages 15–30 years) presenting to a sports medicine clinic completed a 476 question survey covering topics related to relative energy deficiency in sport (RED-S), including female athlete triad risk factors and athletic activity. For the purpose of this study, data was extracted from responses by subjects between 15–19 years of age. Low EA was defined as meeting = 1 criterion: self-reported history of eating disorder/disordered eating (ED/DE), high score on the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and/or high score on the Eating Disorder Screen for Primary Care (ESP). UI was assessed through a modified form of the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence (ICIQ-UI Short Form). Descriptive statistics are expressed as mean ± standard deviation and associations between EA status and UI queries were assessed by chi-squared analysis (cut off for statistical significance was defined as: p<0.05). RESULTS: Of those who completed the survey, 70.8% were adolescents between 15 and 19 years of age. UI during athletic activities was reported by 14.4% of these athletes. Of those reporting UI, UI was significantly more common in those with low EA than those with adequate EA (54.9% vs. 45.1%, p=0.003). Age was not associated with UI in this subset (p=0.83). The median onset of UI was 1–2 years prior to completing the survey and the median frequency of UI over the previous year was reported as weekly. There was no significant correlation between the presence of menstrual dysfunction and UI (p=0.104). CONCLUSIONS: Our findings demonstrate that UI is a common problem among adolescent female athletes, occurring in 14.4% of 15-19 year old female athletes surveyed in this study. UI is more prevalent in adolescent female athletes with low EA in comparison to female athletes with adequate EA. These findings are consistent with those previously observed in studies involving older populations of adult female athletes with eating disorders, where UI was more prevalent in those with low EA in comparison to controls with adequate EA. These findings suggest a potential place for genitourinary disorders in the constellation of impaired physiologic functions considered associated with low EA in athletes/RED-S, and offers a window into a commonly overlooked clinical problem impacting young female athletes.

Pitfalls of Conducting and Interpreting Estimates of Energy Availability in Free-Living Athletes

2018 ◽  
Vol 28 (4) ◽  
pp. 350-363 ◽  
Author(s):  
Louise M. Burke ◽  
Bronwen Lundy ◽  
Ida L. Fahrenholtz ◽  
Anna K. Melin
Keyword(s):  
Energy Intake ◽  
Good Health ◽  
Relative Energy ◽  
Fat Free Mass ◽  
Energy Availability ◽  
Response Patterns ◽  
Male Athletes ◽  
Energy Deficiency ◽  
Definition Of ◽  
Residual Errors

The human body requires energy for numerous functions including, growth, thermogenesis, reproduction, cellular maintenance, and movement. In sports nutrition, energy availability (EA) is defined as the energy available to support these basic physiological functions and good health once the energy cost of exercise is deducted from energy intake (EI), relative to an athlete’s fat-free mass (FFM). Low EA provides a unifying theory to link numerous disorders seen in both female and male athletes, described by the syndrome Relative Energy Deficiency in Sport, and related to restricted energy intake, excessive exercise or a combination of both. These outcomes are incurred in different dose–response patterns relative to the reduction in EA below a “healthy” level of ∼45 kcal·kg FFM−1·day−1. Although EA estimates are being used to guide and monitor athletic practices, as well as support a diagnosis of Relative Energy Deficiency in Sport, problems associated with the measurement and interpretation of EA in the field should be explored. These include the lack of a universal protocol for the calculation of EA, the resources needed to achieve estimates of each of the components of the equation, and the residual errors in these estimates. The lack of a clear definition of the value for EA that is considered “low” reflects problems around its measurement, as well as differences between individuals and individual components of “normal”/“healthy” function. Finally, further investigation of nutrition and exercise behavior including within- and between-day energy spread and dietary characteristics is warranted since it may directly contribute to low EA or its secondary problems.

2 The prevalence of musculoskeletal injuries, menstrual irregularity and disordered eating in junior elite athletics in the UK

2021 ◽  
Vol 55 (16) ◽  
pp. 940.2-941
Author(s):  
J Wilkinson ◽  
L Mayhew
Keyword(s):  
Disordered Eating ◽  
Sports Medicine ◽  
Injury Risk ◽  
Relative Energy ◽  
Track And Field ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Menstrual Dysfunction ◽  
Energy Deficiency ◽  
The Uk

The prevalence of injury in adolescent elite track and field competitors is high,1 however only one study has been conducted with UK athletes.2 Relative Energy Deficiency in Sport (RED-S), encapsulating the Female Athlete Triad, is a syndrome whereby decreased energy availability affects health and performance, potentially leading to an increased injury risk; particularly to bone (3). Calculating decreased energy availability is difficult, however identifying contributing factors, such as disordered eating and menstrual dysfunction, is more viable.3AimThis study was conducted to identify the prevalence of musculoskeletal injury, disordered eating and menstrual dysfunction in elite junior UK track and field athletes.MethodData was collected from track and field athletes ranked within the top 10 of the UK U17 rankings in 2017 or 2018, with 138 athletes participating. Participants completed a self-reported musculoskeletal injury, disordered eating and menstrual dysfunction questionnaire relating to a 12-month time period.ResultsThis study found a 12-month retrospective injury prevalence of 43.5%. 13% of participants presented with disordered eating, whilst 37.7% of female participants presented with menstrual dysfunction. There was a statistically significant difference in injury prevalence according to gender, with more male athletes sustaining an injury compared with female athletes. No differences in injury prevalence were noted according to event group, menstrual dysfunction or disordered eating. The anatomical location displaying the highest prevalence of injury was the ankle and foot (22.5%). The anatomical structure displaying the highest 12-month injury prevalence was muscle (43.6%), followed by bone (30.9%). Additionally, 21.7% of respondents reported having previously sustained a stress fracture prior to taking part in this study.ConclusionThere is a high prevalence of injuries in junior UK track and field athletes, with most injuries affecting the lower limb. Although there was no difference noted in injury risk for athletes with menstrual dysfunction or disordered eating, the prevalence of bone injuries was alarmingly high. This study indicates the requirement for future research investigating RED-S within this population.ReferenceZemper, E. Track andField Injuries. In: Caine DJ, Maffulli N. (eds). Epidemiology of Pediatric Sports Injuries. Individual Sports. Med Sport Science: Volume 48. Basel, Karger; 2005. p. 138–151D’Souza D. Track and field athletics injuries - a one-year survey. British Journal of Sports Medicine 1994; 28 (3): 197–202.Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine 2014; 48: 491–497.

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