scholarly journals A Narrative Review on Female Physique Athletes: The Physiological and Psychological Implications of Weight Management Practices

2019 ◽  
Vol 29 (6) ◽  
pp. 682-689 ◽  
Author(s):  
Nura Alwan ◽  
Samantha L. Moss ◽  
Kirsty J. Elliott-Sale ◽  
Ian G. Davies ◽  
Kevin Enright
Keyword(s):  
Weight Management ◽  
Management Practices ◽  
Female Athletes ◽  
Narrative Review ◽  
Low Energy ◽  
Energy Availability ◽  
Intensive Training ◽  
Aesthetic Appearance ◽  
Increased Risk ◽  
Low Energy Availability

Physique competitions are events in which aesthetic appearance and posing ability are valued above physical performance. Female physique athletes are required to possess high lean body mass and extremely low fat mass in competition. As such, extended periods of reduced energy intake and intensive training regimens are used with acute weight loss practices at the end of the precompetition phase. This represents an increased risk for chronic low energy availability and associated symptoms of relative energy deficiency in sport, compromising both psychological and physiological health. Available literature suggests that a large proportion of female physique athletes report menstrual irregularities (e.g., amenorrhea and oligomenorrhea), which are unlikely to normalize immediately postcompetition. Furthermore, the tendency to reduce intakes of numerous essential micronutrients is prominent among those using restrictive eating patterns. Following competition, reduced resting metabolic rate, and hyperphagia, is also a concern for these female athletes, which can result in frequent weight cycling, distorted body image, and disordered eating/eating disorders. Overall, female physique athletes are an understudied population, and the need for more robust studies to detect low energy availability and associated health effects is warranted. This narrative review aims to define the natural female physique athlete, explore some of the physiological and psychological implications of weight management practices experienced by female physique athletes, and propose future research directions.

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.

scholarly journals Examining the Relationship between Exercise Dependence, Disordered Eating, and Low Energy Availability

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2601
Author(s):  
Megan A. Kuikman ◽  
Margo Mountjoy ◽  
Jamie F. Burr
Keyword(s):  
Disordered Eating ◽  
Female Athletes ◽  
Signs And Symptoms ◽  
Low Energy ◽  
Exercise Dependence ◽  
Energy Availability ◽  
Recreational Athletes ◽  
Bone Stress ◽  
Increased Risk ◽  
Low Energy Availability

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.

Hepcidin as a Prospective Individualized Biomarker for Individuals at Risk of Low Energy Availability

2019 ◽  
Vol 29 (6) ◽  
pp. 671-681 ◽  
Author(s):  
Claire E. Badenhorst ◽  
Katherine E. Black ◽  
Wendy J. O’Brien
Keyword(s):  
Iron Deficiency ◽  
Iron Homeostasis ◽  
Dietary Intervention ◽  
Low Energy ◽  
Energy Availability ◽  
Dietary Interventions ◽  
Hepcidin Expression ◽  
Ketogenic Diets ◽  
Increased Risk ◽  
Low Energy Availability

Hepcidin, a peptide hormone with an acknowledged evolutionary function in iron homeostasis, was discovered at the turn of the 21st century. Since then, the implications of increased hepcidin activity have been investigated as a potential advocate for the increased risk of iron deficiency in various health settings. Such implications are particularly relevant in the sporting community where peaks in hepcidin postexercise (∼3–6 hr) are suggested to reduce iron absorption and recycling, and contribute to the development of exercise-induced iron deficiency in athletes. Over the last decade, hepcidin research in sport has focused on acute and chronic hepcidin activity following single and repeated training blocks. This research has led to investigations examining possible methods to attenuate postexercise hepcidin expression through dietary interventions. The majority of macronutrient dietary interventions have focused on manipulating the carbohydrate content of the diet in an attempt to determine the health of athletes adopting the low-carbohydrate or ketogenic diets, a practice that is a growing trend among endurance athletes. During the process of these macronutrient dietary intervention studies, an observable coincidence of increased cumulative hepcidin activity to low energy availability has emerged. Therefore, this review aims to summarize the existing literature on nutritional interventions on hepcidin activity, thus, highlighting the link of hepcidin to energy availability, while also making a case for the use of hepcidin as an individualized biomarker for low energy availability in males and females.

scholarly journals Low Energy Availability Associated With Lower BMD And Bone Stress Injury Site In Female Athletes

2018 ◽  
Vol 50 (5S) ◽  
pp. 742-743
Author(s):  
Bryan Holtzman ◽  
Allyson L. Parziale ◽  
Katherine M. Cooper ◽  
Erin Flynn ◽  
Adam S. Tenforde ◽  
...  
Keyword(s):  
Female Athletes ◽  
Low Energy ◽  
Energy Availability ◽  
Stress Injury ◽  
Injury Site ◽  
Bone Stress ◽  
Low Energy Availability

scholarly journals Risk of Low Energy Availability among Female and Male Elite Runners Competing at the 26th European Cross-Country Championships

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 873
Author(s):  
Filipe Jesus ◽  
Inês Castela ◽  
Analiza M Silva ◽  
Pedro A. Branco ◽  
Mónica Sousa
Keyword(s):  
At Risk ◽  
Female Athletes ◽  
Low Energy ◽  
Multidisciplinary Teams ◽  
Energy Availability ◽  
High Prevalence ◽  
Bowel Movements ◽  
Cross Country ◽  
Low Energy Availability ◽  
Normal Menstruation

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.

scholarly journals Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 835 ◽  
Author(s):  
Danielle M. Logue ◽  
Sharon M. Madigan ◽  
Anna Melin ◽  
Eamonn Delahunt ◽  
Mirjam Heinen ◽  
...  
Keyword(s):  
At Risk ◽  
Relative Energy ◽  
Narrative Review ◽  
Low Energy ◽  
Screening Tools ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Exercise Energy Expenditure ◽  
And Gender ◽  
Low Energy Availability

Low energy availability (EA) underpins the female and male athlete triad and relative energy deficiency in sport (RED-S). The condition arises when insufficient calories are consumed to support exercise energy expenditure, resulting in compromised physiological processes, such as menstrual irregularities in active females. The health concerns associated with longstanding low EA include menstrual/libido, gastrointestinal and cardiovascular dysfunction and compromised bone health, all of which can contribute to impaired sporting performance. This narrative review provides an update of our previous review on the prevalence and risk of low EA, within-day energy deficiency, and the potential impact of low EA on performance. The methods to assess EA remain a challenge and contribute to the methodological difficulties in identifying “true” low EA. Screening female athletic groups using a validated screening tool such as the Low Energy Availability in Females Questionnaire (LEAF-Q) has shown promise in identifying endurance athletes at risk of low EA. Knowledge of RED-S and its potential implications for performance is low among coaches and athletes alike. Development of sport and gender-specific screening tools to identify adolescent and senior athletes in different sports at risk of RED-S is warranted. Education initiatives are required to raise awareness among coaches and athletes of the importance of appropriate dietary strategies to ensure that sufficient calories are consumed to support training.

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 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.

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