Nutritional Strategies for Optimizing Health, Sports Performance, and Recovery for Female Athletes and Other Physically Active Women: A Systematic Review.

CONTEXT: Despite the progress toward gender equality in events like the Olympic Games and other institutionalized competitions, and the rising number of women engaging in physical exercise programs, scientific studies focused on establishing specific nutritional recommendations for female athletes and other physically active women are scarce. OBJECTIVE: This systematic review aimed to compile the scientific evidence available for addressing the question "What dietary strategies, including dietary and supplementation approaches, can improve sports performance, recovery, and health status in female athletes and other physically active women?" DATA SOURCES: The Pubmed, Web of Science, and Scopus databases were searched. DATA EXTRACTION: The review process involved a comprehensive search strategy using keywords connected by Boolean connectors. Data extracted from the selected studies included information on the number of participants and their characteristics related to sport practice, age, and menstrual function. DATA ANALYSIS: A total of 71 studies were included in this review: 17 focused on the analysis of dietary manipulation, and 54 focused on the effects of dietary supplementation. The total sample size was 1654 participants (32.5% categorized as competitive athletes, 30.7% as highly/moderately trained, and 37.2% as physically active/recreational athletes). The risk of bias was considered moderate, mainly for reasons such as a lack of access to the study protocol, insufficient description of how the hormonal phase during the menstrual cycle was controlled for, inadequate dietary control during the intervention, or a lack of blinding of the researchers. CONCLUSION: Diets with high carbohydrate (CHO) content enhance performance in activities that induce muscle glycogen depletion. In addition, pre-exercise meals with a high glycemic index or rich in CHOs increase CHO metabolism. Ingestion of 5-6 protein meals interspersed throughout the day, with each intake exceeding 25 g of protein favors anabolism of muscle proteins. Dietary supplements taken to enhance performance, such as caffeine, nitric oxide precursors, ß-alanine, and certain sport foods supplements (such as CHOs, proteins, or their combination, and micronutrients in cases of nutritional deficiencies), may positively influence sports performance and/or the health status of female athletes and other physically active women. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD480674.

Risk and prevalence of Relative Energy Deficiency in Sport (REDs) among professional female football players.

A high prevalence of low energy availability (LEA) has been reported in female football players. This is of concern as problematic LEA may evolve into a syndromic pattern known as relative energy deficiency in sport (REDs). Given the difficulties in accurately assessing LEA, our study shifts emphasis to measurable indicators of REDs, serving as proxies for health detriments caused by LEA. The present cross-sectional study aimed to quantify the risk of REDs and to assess the prevalence of indicators indicative of the syndrome. 60 players (tiers 3 and 4) from three Norwegian football teams were analyzed as a single cohort but also stratified based on player position and menstrual status. The proportion of players at risk for REDs was 22%, that is, 17% with mild, 3% with moderate to high, and 2% with very high/extreme risk, respectively. The majority of the cohort (71%) presented with no primary indicators, while 20%, 7%, and 2% presented with one, two, and three primary indicators, respectively. Regarding secondary indicators, 57% had none, 33% had one, and 10% had two indicators. For associated indicators, 30% had none, 42% had one, 18% had two, 8% had three, and 2% had four indicators. Player position did not affect the prevalence of REDs indicators. Among noncontraceptive users (n = 27), secondary amenorrhea (AME) was reported by 30%. These findings indicate that health and performance teams should prioritize universal health promoting strategies rather than selective or indicative strategies. Particularly, focus on nutritional periodization to secure sufficient energy availability, mitigating the risk of problematic LEA and REDs should be addressed.

Risk Factors for Shoulder Injuries in Female Athletes Playing Overhead Sports: A Systematic Review.

CONTEXT: Sports involving overhead motions put substantial biomechanical demands on the shoulder and may result in injuries. OBJECTIVE: To determine risk factors (RFs) for shoulder injuries in female athletes who play overhead sports and evaluate strategies to reduce shoulder injuries in these athletes. DATA SOURCES: A systematic electronic search was performed according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Databases included were PubMed, Tulane Matas Library Search Engine, and Google Scholar, with search terms: "Overhead injuries/Shoulder AND female athletes AND Risk Factors." STUDY SELECTION: Of the initial 1574 studies identified, 314 were evaluated for eligibility by full-text review and 291 studies were excluded. Overall, 23 studies were included in this study. Studies were published from 2000 to 2021, subject age range was 15 to 35 years, with documented prevalence of shoulder injuries in female athletes playing overhead sports. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 2. DATA EXTRACTION: Two independent researchers completed abstract and full-text review. Data extraction used the Covidence and Cochrane Consumer guide template. RESULTS: Volleyball was the most common sport with shoulder injuries (6/23; 26%) followed by softball 5/23 (22%), swimming 5/23 (22%), gymnastics 4/23 (17%), tennis 3/23 (13%), water polo 2/23 (8%), and basketball 1/23 (4%). Six RFs (dominant shoulder, volume/overuse, time in sport, older age at time of injury, past injury, and multidirectional instability) were described. Of the 23 studies, 9 (39%) identified the dominant shoulder as a RF for sustaining injury (mean risk ratio [RR], 2.04), while 6 (26%) cited volume of repetition and overuse as a prominent RF (RR, 1.45). CONCLUSION: This systematic review demonstrates important RFs for shoulder injuries in female athletes associated with playing overhead sports. Multiple prevention strategies are described. Prevention programs are helpful in reducing the risk of reinjury.

The Myometric Assessment of Achilles Tendon and Soleus Muscle Stiffness before and after a Standardized Exercise Test in Elite Female Volleyball and Handball Athletes-A Quasi-Experimental Study.

Background: The high prevalence of injuries in female athletes necessitates a course of action that not only enhances research in this field but also incorporates improved prevention programs and regular health monitoring of highly stressed structures such as tendons and muscles. Since myometry is already used by coaches and physiotherapists, it is important to investigate whether tissue stiffness varies in different types of sports, and whether such measures are affected by an acute training session. Methods: Myometric measurements of the Achilles tendon (AT) and soleus muscle (SM) were performed in the longitudinal plane and relaxed tendon position. In total, 38 healthy professional female athletes were examined, applying a quasi-experimental study design, with subgroup analysis performed for different sports. To investigate the stiffness of the AT and SM, 24 female handball and volleyball athletes performed a standardized maximal incremental performance test on a treadmill. In this subgroup, myometric measurements were taken before and after the exercise test. Results: The measurements showed no significant difference between the mean pre- (AT: 661.46 N/m; SM 441.48 N/m) and post-exercise stiffness (AT: 644.71 N/m; SM: 439.07 N/m). Subgroup analysis for different types of sports showed significantly lower AT and SM stiffness in swimming athletes compared to handball (p = 0.002), volleyball (p = 0.000) and hammer throw athletes (p = 0.008). Conclusions: Myometry can be performed on the same day as an acute training session in healthy female professional volleyball and handball athletes. Female swimmers have significantly lower AT and SM stiffness compared to female handball, volleyball and hammer throw athletes. These results show that the stiffness differences in the AT and SM can be assessed by myometry.

The risk of low energy availability among athlete females in Saudi Arabia: a cross-sectional study.

Introduction: Low energy availability (LEA) is a state of inadequate energy reserves that results from a negative energy balance. This condition can lead to severe health risks such as amenorrhea and osteoporosis. Various causes for LEA, such as eating disorders and exercise addiction, have been reported in the literature. However, data in Saudi Arabia are lacking. This cross-sectional study measures the prevalence of LEA, eating disorders, and exercise addiction among adult females in Saudi Arabia and identifies possible associated risk factors. Methods: The sample comprised 119 female athletes who filled out an online survey adapted from the LEA in Females Questionnaire, the Eating Disorder Examination Questionnaire, and the Exercise Addiction Inventory. Results: Participants showed a high prevalence of LEA (66.4%), eating disorder (33.6%), and exercise addiction (10.1%), confirming the association between normal weight and LEA in females living in Saudi Arabia (p < 0.00). Discussion and conclusion: With an increasing number of females in the country interested in following a healthy lifestyle, there is a need to raise the awareness of the population on the issues of LEA, eating disorders, and exercise addiction and their effects on the body by developing educational programs about energy intake and healthy physical activity routines.

Menstrual Cycle Hormone Relaxin and ACL Injuries in Female Athletes: A Systematic Review.

Background: Female athletes are at increased risk for anterior cruciate ligament (ACL) injuries. The influence of hormonal variation on female ACL injury risk remains ill-defined. Recent data suggests that the collagen-degrading menstrual hormone relaxin may cyclically impact female ACL tissue quality. This review aims to identify any correlation between menstrual relaxin peaks and rates of female ACL injury. Methods: A systematic review was performed, utilizing the MEDLINE, EMBASE, and CINAHL databases. Included studies had to directly address relaxin/female ACL interactions. The primary outcome variable was relaxin proteolysis of the ACL, at cellular, tissue, joint, and whole-organism levels. The secondary outcome variable was any discussed method of moderating relaxin levels, and the clinical results if available. Results: AllThe numerous relaxin receptors on female ACLs upregulate local collagenolysis and suppress local collagen production. Peak serum relaxin concentrations (SRC) occur during menstrual cycle days 21-24; a time phase associated with greater risk of ACL injury. Oral contraceptives (OCPs) reduce SRC, with a potential ACLprotective effect. Conclusion: A reasonable correlative and plausible causative relationship exists between peak relaxin levels and increased risk of ACL injury in females, and further investigation is warranted. Level of Evidence: III.

Evidence of weight loss in junior female judo athletes affects their development.

Purpose: The facile manipulation of body weight in junior athletes has the potential to pose significant risks to their lifelong health. In judo, which is a weight class sport, pre-competition weight loss is widespread even among juniors, but information on the current situation is scarce, especially for female athletes, for whom it is important to provide adequate nutrition and enhance bone mass during the growth period, and the details of the current situation are not clear. Therefore, the purpose of this study was to determine the actual weight loss during the growth period in junior female judo athletes and its subsequent impact on their health. Methods: The survey was a cross-sectional survey of junior female judo athletes in Japan using a questionnaire. Participants were asked to respond via an online questionnaire about their weight, height, weight loss experience, menstruation, competition results, and other lifestyle. Results: 51.8% of subjects experienced weight loss for competition during their junior high school years (ages 12-15). Those who experienced weight loss during secondary sexual characteristics were found to be significantly shorter in current height than those who did not (p < 0.05). Weight loss during secondary sexual characteristics did not affect current menstrual cycle. There was no significant difference in competition results due to the experience of weight loss during junior high school (χ 2 = 4.485, df = 3, n.s.). Conclusions: These findings suggest that weight loss during the growth spurt phase may adversely impact normal development. It also suggested that weight loss during the junior high school years may not be a strategy to bring about better competition results. These observations indicate the need for education on appropriate class selection and weight control for junior athletes in weight class competitions.

Ankle sprain, concussion, and anterior cruciate ligament injuries are common and burdensome in sub-elite female Australian football players.

OBJECTIVES: To describe the epidemiology of injuries in sub-elite female Australian Football (AF). DESIGN: Prospective cohort. METHODS: 424 athletes were tracked across a 12-match season. Injury characteristics (location, severity, mechanism) were reported. Injury incidence (injuries per 1000 h) and injury burden (days absent per 1000 h) were calculated. Severity was considered as the number of days missed between injury onset and return to full training. Incidence was compared using incidence rate ratios, and severity using a Mann-Whitney U test. RESULTS: Total injury incidence was 10.8 (95 % confidence interval [CI] = 9.0, 12.8) injuries per 1000 h. Match incidence was 34.6 (95 % CI = 28.0, 42.4) injuries per 1000 h. Ankle sprain injuries (2.2 per 1000 h, 95 % CI = 1.4, 3.1) and concussion (1.6 per 1000 h, 95 % CI = 1.0, 2.5) injuries were the most frequent, followed by anterior cruciate ligament (ACL) injuries (0.9 per 1000 h, 95 % CI = 0.4, 1.6). ACL (40.4 days per 1000 h, 95 % CI = 36.9, 44.1), ankle sprain injuries (31.4 per 1000 h, 95 % CI =28.4, 34.7), and concussion (19.9 per 1000 h, 95 % CI = 17.5, 22.5) injuries were also the most burdensome. There were 78 mild, 34 moderate, and 21 severe injuries. ACL injuries were the most severe injury (56.0 [77.0] in-season days missed). CONCLUSIONS: This research describes the first large-scale injury profile of sub-elite female AF, reporting time-loss measures of incidence and burden for many injury types. Ankle sprain injuries, concussions, and ACL injuries are common and burdensome, and should be prioritised for prevention.

Auditing the Representation of Female Athletes in Sports Medicine Research: Achilles Repair.

Background: Establishing evidence-based recommendations specific to female athletes has been overlooked in sports medicine. Achilles tendon rupture is one of the most common musculoskeletal injuries, occurring in 15 to 55 per 100 000 people annually. Differences in injury rates could be due to hormonal effects, as estrogen receptors have been identified in tendons along with decreased tendon strain based on oral contraceptive use. The primary purpose of this study was to audit the representation of female athletes in the literature regarding Achilles repair. Methods: An electronic search was performed using PubMed to identify articles related to Achilles repair using the protocol by Smith et al. Studies were assessed by population, size, athletic caliber, study impact, research theme, and menstrual status. Results: Female representation across all studies was 1783 of 10 673 subjects (16.7%). Composition of included studies was predominantly mixed-sex cohorts with 131 of 169 (77.5%) included studies. Within mixed-sex cohort studies, the total representation of female athletes was 1654 of 8792 participants (18.9%). Thirty-two studies were male only, constituting 1540 participants, whereas 3 studies were female only composed of 86 athletes. Importantly, the disparity between male and female representation worsened as the athletic caliber of the study population increased, with 5.0% female representation in studies with professional athletes. No study collected data related to menstrual status and its potential relationship to Achilles rupture or postoperative outcomes. Conclusion: Mixed-sex cohort studies underrepresented female athletes, and male-only cohort studies were more common than female-only studies. These findings indicate a need for increased representation of female athletes as well as acknowledgment of menstrual status in research related to Achilles repair. Future studies should focus on representation of female athletes and data collection related to sex-specific hormones, hormonal contraceptive use, and menstrual status to improve treatment of Achilles tendon ruptures for female athletes. Level of Evidence: Level IV, case series.

Injury profiles in sub-elite Women's Cricket: Exploring incidence, prevalence, nature, onset and body region.

INTRODUCTION: The rise in participation in sports, like women's cricket, is linked with increased injury risk. Providing high-level longitudinal data is the first step in implementing evidence-based injury prevention strategies. DESIGN: Prospective cohort study. OBJECTIVE: This cohort study aims to describe the injury profiles in sub-elite women's cricket in South Africa during the 2022/23 season. METHODS: Injuries were prospectively recorded using injury surveillance questionnaires, injury surveillance database, and logbooks completed by each team's medical staff. Injury rates were investigated for match and training days, body region, player role, nature, and activity at the time of injury. RESULTS: Three teams with a total of 44 players (20.86 ± 1.6 years) were included in the study. Injury incidence was 85.23 per 1000 player match days, 15.91 for match time-loss and 69.32 for non-time-loss, with 2.95% of players unavailable for match selection on any day. Fast bowlers had the highest injury incidence. Fielding caused 46.67% of all injuries. Injury incidence was higher in training than in matches. The wrist/hand had the highest injury incidence and caused the most match time-loss. CONCLUSION: This study provides valuable insights regarding the current injury rates in sub-elite female cricket players.

Pelvic Floor Muscle Training on Stress Urinary Incontinence in Power- and Weightlifters: a Pilot Study.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) is defined as involuntary leakage of urine on physical effort and is prevalent among power- and weightlifters. However, there is scant knowledge on treatment options for this population. The aim of this pilot study was to evaluate the potential outcomes and feasibility of a pelvic floor muscle training (PFMT) program on SUI in nulliparous female power- and weightlifters. METHODS: This was a case-series study, including one weightlifter and two powerlifters aged 21-32 years. The participants conducted 12 weeks of PFMT at home, with weekly follow-up by a physiotherapist. Change in total score of the International Consensus of Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was the primary outcome. Secondary outcome was perceived change assessed by the Patient Global Impression of Improvement (PGI-I) Scale and impact on sport participation. PFM strength, endurance, and resting pressure was measured using vaginal manometry. Feasibility was evaluated as adherence to training and self-efficacy (Self Efficacy Scale for Practicing Pelvic Floor Exercises). RESULTS: One athlete reduced their ICIQ-UI-SF score and experienced improvement in symptoms. One athlete reported no change, and one reported a worsening of symptoms. All three participants improved PFM strength and endurance, completed the testing, and 12 weeks of PFMT, but adherence varied between 40 and 80%. Participants reported a lack of time and energy and forgetting to perform the exercises, as reasons for low adherence. CONCLUSION: There were varying effects of a 12-week PFMT program on SUI in three strength athletes. The results can create the basis for a future randomized controlled trial.

Patterns of energy availability and carbohydrate intake differentiate between adaptable and problematic low energy availability in female athletes.

Background: Problematic low energy availability (EA) is the underlying culprit of relative energy deficiency in sport (REDs), and its consequences have been suggested to be exacerbated when accompanied by low carbohydrate (CHO) intakes. Objectives: This study compared dietary intake, nutrition status and occurrence of REDs symptoms in groups of female athletes, displaying different patterns of EA and CHO intake. Methods: Female athletes (n = 41, median age 20.4 years) from various sports weighed and recorded their food intake and training for 7 consecutive days via a photo-assisted mobile application. Participants were divided into four groups based on patterns of EA and CHO intakes: sufficient to optimal EA and sufficient to optimal CHO intake (SEA + SCHO), SEA and low CHO intake (SEA + LCHO), low energy availability and SCHO (LEA + SCHO), and LEA and LCHO (LEA + LCHO). SEA patterns were characterised by EA ≥30 and LEA by EA <30 kcal/kg fat free mass, and SCHO patterns characterised by CHO intake ≥3.0 and LCHO <3.0 g/kg body weight for most of the registered days. Body composition was measured with dual energy x-ray absorptiometry, resting metabolic rate with indirect calorimetry and serum blood samples were collected for evaluation of nutrition status. Behavioural risk factors and self-reported symptoms of REDs were assessed with the Low Energy Availability in Females Questionnaire, Eating Disorder Examination Questionnaire Short (EDE-QS), Exercise Addiction Inventory, and Muscle Dysmorphic Disorder Inventory. Results: In total, 36.6% were categorised as SEA + SCHO, of which 5/16 were ball sport, 7/10 endurance, 1/7 aesthetic, 2/5 weight-class, and 0/3 weight-class athletes. Of LEA + LCHO athletes (19.5% of all), 50% came from ball sports. Aesthetic and endurance athletes reported the greatest training demands, with weekly training hours higher for aesthetic compared to ball sports (13.1 ± 5.7 vs. 6.7 ± 3.4 h, p = 0.012). Two LEA + LCHO and one SEA + LCHO athlete exceeded the EDE-QS cutoff. LEA + LCHO evaluated their sleep and energy levels as worse, and both LEA groups rated their recovery as worse compared to SEA + SCHO. Conclusion: Repeated exposures to LEA and LCHO are associated with a cluster of negative implications in female athletes. In terms of nutrition strategies, sufficient EA and CHO intakes appear to be pivotal in preventing REDs.

The developmental activities of women's professional pathway cricketers.

The growth of investment in women's cricket has led to the development of new professional pathways. However, there is lack of specific evidence to support the development of these athletes. This study aimed to take a first step in understanding the participation histories of female cricketers selected into English women's professional academies. 84 players completed the Participation History Questionnaire (PHQ) to capture details of activities engaged in across development, including milestones, cricket activity, and engagement in other sport activities. There were relative age effects where players' birthdate distributions differed from national norms (X2 = 8.451, p = .003, V = 0.227), and more players than expected attended independent schools (X2 = 7.980, p = .005, V = 0.232). Participants engaged in cricket informally before coach led training, have siblings (particularly brothers) interested in cricket and often played boy's cricket before engaging in the girl's or women's game. Developmental activities were characterised by early engagement, high levels of diversification, and very low levels of play compared to high levels of formal practice and match play. These findings have implications for the advancement of talent identification and development policies and processes in women's cricket.

Return to play and athletic performance in division I female volleyball players following anterior cruciate ligament injury.

OBJECTIVES: The purpose of this study is to examine NCAA Division I volleyball players' return to play rates and performance statistics compared to pre-injury levels following ACL injury. METHODS: Female volleyball players that sustained ACL injuries from 2008 to 2020 and competed in one of seven collegiate conferences (n = 99) were identified via an internet search algorithm. Players were categorized by position, academic year, and playing time pre- and post-injury. Post-injury performance statistics were gathered for a subset of outside hitters and middle blockers that played in ≥35 sets in a single season for up to 3 years following injury (mean 1.7 seasons). A control group (n = 512) was generated for demographic and statistical comparison. Mean pre-injury and post-injury statistics were compared for players that did not change positions and played ≥35 sets before and after injury. RESULTS: Volleyball attackers were 54.7% of the control population but sustained 78.8% of identified injuries. Following ACL injury, 6.1% of players registered no in-game statistics, 16.2% played in <35 sets, 65.7% played in ≥35 sets, and 12.1% graduated. Mean performance statistics increased linearly the more years players were from ACL injury. CONCLUSIONS: Female collegiate volleyball players return to play following ACL injury at high rates (93.1%) and maintain pre-injury performance levels. Volleyball attackers sustain ACL injuries more commonly than setters and libero/defensive specialists.

Effects of Education, Nutrition, and Psychology on Preventing the Female Athlete Triad.

The female athlete triad is a syndrome occurring in young female athletes defined by menstrual dysfunction, decreased energy availability (EA), and low bone mineral density (BMD). Although the triad includes these three conditions, not all three need to occur simultaneously for the diagnosis to be made. The goal of this review is to analyze published research on the female athlete triad and determine prevention methods in athletics. A review of 23 published sources using the PubMed database identified key recommendations, including education resources, psychological factors, and nutrition. It is recommended that athletes, parents, coaches, and healthcare professionals should learn about the risk factors, warning signs, and diagnosis for better prevention. Research revealed that eating disorders, self-esteem issues, and coach-athlete relationships should be evaluated and potentially managed with counseling. Finally, nutritional recommendations included maintaining EA, providing nutritional counseling, and proper nutritional education. Early intervention with proper education, psychological support, and nutritional management are vital to preventing the onset of the female athlete triad.

Determinants of menstrual dysfunction in the female athlete triad: A cross-sectional study in Italian athletes.

BACKGROUND: In 1992 the American College of Sports Medicine first described the Female Athlete Triad. The Triad is a metabolic injury involving three distinct clinical traits: low energy availability, with possible eating disorder, low bone mineral density and menstrual dysfunction (MD). Although the estimated prevalence of the Triad is low (1.2 %), single factors are common in female athletes, at all competitive levels and ages. Even though the Triad was described over two decades ago, the interrelation of the three diagnostics components is still debated: additional evidence is required to improve the multidisciplinary treatment approach for this complex condition. MD is one of the first signs of energy impairment. The present study aims at investigating MD determinants and predictors in female athletes, to allow an early diagnosis of the Triad and to implement adequate preventive strategies. MATERIALS AND METHODS: An original structured questionnaire was composed to detect the presence of MD risk factors. Included participants were active female athletes within reproductive age range (15-40 years old). Anthropometric parameters and training-related factors, possibly affecting the regularity of the menstrual cycle, were investigated. RESULTS: Respondents were 288 female athletes. Among them, 73.3 % were under 25 years of age; 6.6 % resulted underweight; 30.6 % reported to follow a meal plan/diet and 13.9 % declared to be a smoker. Lean sports were practiced by 30.6 % of responders. Body-weight congruence was detected in in 79.9 % of participants, whereas overestimation of body image was found in 16.3 % of athletes. Irregular menstrual cycle, a possible MD predictor, was present in 33.0 % of athletes, with 41.1 % practicing some lean sport (p = 0.007). Also, overestimation of body image suggested an increased risk of menstrual irregularity (p = 0.001). BMI <18.5 or BMI >30 could also act as risk factor, although significance was not fully obtained (p = 0.053). Overall, practice of lean sports and overestimation of body image appeared good determinants of increased menstrual irregularity (AOR 2.02 and 3.83, respectively). CONCLUSIONS: Menstrual irregularity in female athletes can be considered an early predictor of MD: risk is further increased in athletes of lean sports and reporting an overestimation of self-perceived body image. Screenings and awareness programs should specifically address female athletes, because of their vulnerable-group profile. In order to define a standardized at-risk profile for Triad onset and sequelae likelihood, evaluation of menstrual regularity should especially be considered, in conjunction with the assessment of other indicators of energy availability (e.g. TEE, lean and fat mass, BMC). Testing for sport-derived stress and disordered eating attitudes is also recommended. Preventive strategy should involve the proactive engagement of sport clubs and periodic competitive sport medical assessment.

Body morphology and handgrip strength parameters of the female canoe slalom paddlers.

Introduction: Canoe slalom is a physically very demanding discipline, in which body constitution, body composition, and relative strength are significant factors in high performance. Although anthropometric and strength parameters are relatively well-studied in male athletes, there is a lack of evidence for any conclusions in women. Therefore, the objective of this study was to determine the morphology and upper-limb strength parameters of female canoe slalom paddlers and identify whether morphological differences exist between performance groups. Methods: Altogether, 63 female competitors of the 2023 ICF Canoe Slalom World Cup (n = 29) and 2023 ICF Canoe Slalom World Ranking Competition (n = 34) in Prague (Czech Republic) were examined with a battery of anthropometric tests, segmental bioimpedance analysis, and handgrip strength test. The athletes were divided into groups according to age and performance: elite athletes belonging to the world top 10 according to the ICF World Ranking (WORLD, n = 7), international-level athletes competing during the World Cup (ELITE, n = 22), international-level junior athletes competing in the World Ranking Race (JUNIOR, n = 17), and other lower performance-level athletes competing in the World Ranking Race (REST, n = 17). Results: Female slalom paddlers are, in general, of average body height (∼165 cm), lower body mass (∼60 kg), BMI (∼22 kg/m2), and body fat (∼20%) and without exceptional anthropometric dimensions and proportions. However, differences were detected when performance was factored in. Female paddlers belonging to the world TOP 10 have the largest circumferences of arms and forearms, and their somatotype is more mesomorphic, with a lower proportion of total body fat and a higher proportion of muscle mass. In addition, the WORLD group differs significantly in upper-limb strength. Discussion: The results shows the significance of muscular strength and power for canoe slalom athletes and the importance of well-developed musculature in operating the boat in the unstable environment. Being a successful female canoe slalom athlete requires a well-developed musculature, maximizing strength capabilities while maintaining a low body weight through limited hypertrophy of the lower limbs and a low level of body fat.

Relative energy deficiency in dance (RED-D): a consensus method approach to REDs in dance.

Relative energy deficiency in sport (REDs) is a potentially severe, challenging, broad-spectrum syndrome with potential negative health and performance outcomes. The numerous research publications and International Olympic Committee consensus statements relating to REDs testify to the challenges faced in early identification or screening, diagnosis and management. Like sport, dance, in its simplest form, can be identified as an activity resulting in physiological energy demands and, as such, requires appropriate energy availability concerning energy expenditures. However, the specificity of physiological and psychological demands in dance must be considered when considering REDs. An environment where physical activity can exceed 30 hours per week and where culture may instil a value that thinness is required puts dancers at increased risk for REDs. The purpose of this study was to provide dance-specific guidance dance on this complex condition. An RAND/UCLA Delphi Panel method with nominal group technique was used to review the literature from REDs to evaluate how it may relate to dance. In addition to the EP, which was assembled from a multidisciplinary background with expertise in REDs and multiple genres of dance, six focus groups were commissioned. Four of the focus groups were drawn from the EP members and two additional focus groups formed by dancers and artistic leaders. These panels were used to guide the development of a RED-D diagnosis pathway, management plan and risk stratification and return to dance pathway. The dance-specific pathways are designed to be a practical tool for guiding and supporting clinicians managing RED-D. Furthermore, this paper represents an important focus of this area in dance and serves to stimulate discussion and further research within the sector.

Relative Energy Deficiency in sport (REDs): Endocrine manifestations, pathophysiology and treatments.

Research on lean, energy-deficient athletic and military cohorts has broadened the concept of the Female Athlete Triad into the Relative Energy Deficiency in Sport (REDs) syndrome. REDs represents a spectrum of abnormalities induced by low energy availability (LEA), which serves as the underlying cause of all symptoms described within the REDs concept, affecting exercising populations of either biological sex. Both short- and long-term LEA, in conjunction with other moderating factors, may produce a multitude of maladaptive changes that impair various physiological systems and adversely affect health, well-being, and sport performance. Consequently, the comprehensive definition of REDs encompasses a broad spectrum of physiological sequelae and adverse clinical outcomes related to LEA, such as neuroendocrine, bone, immune, and hematological effects, ultimately resulting in compromised health and performance. In this review, we discuss the pathophysiology of REDs and associated disorders. We briefly examine current treatment recommendations for REDs, primarily focusing on non-pharmacological, behavioral, and lifestyle modifications that target its underlying cause - energy deficit. We also discuss treatment approaches aimed at managing symptoms, such as menstrual dysfunction and bone stress injuries, and explore potential novel treatments that target the underlying physiology, emphasizing the roles of leptin and the activin-follistatin-inhibin axis, the roles of which remain to be fully elucidated, in the pathophysiology and management of REDs. In the near future, novel therapies leveraging our emerging understanding of molecules and physiological axes underlying energy availability or lack thereof may restore LEA-related abnormalities, thus preventing and/or treating REDs-related health complications, such as stress fractures, and improving performance.

Concussion Rates in Youth Lacrosse Players and Comparison With Youth American Football.

Background: There has been little focus on concussions in youth lacrosse players in the United States. Purpose: To provide a descriptive analysis of the epidemiology and incidence of concussions in youth lacrosse and compare the results with well-documented analyses of concussions in youth American football. Study Design: Descriptive epidemiology study. Methods: Data on concussions in pediatric patients playing lacrosse from 2006 to 2019 were collected using the National Electronic Injury Surveillance System (NEISS). Weighted calculations and combined participation data obtained from membership in USA Lacrosse were used to estimate injury incidence. A comparison dataset was created using the NEISS data on youth football-related concussions. The cause of concussion was categorized into player-to-player, player-to-stick, player-to-ball, or player-to-ground contact. Results: A total of 37,974 concussion injuries related to lacrosse were identified in players with a mean age of 14.5 ± 3.5 years; 70% of concussions occurred in boys. National participation in lacrosse increased from 2006 to 2011 by a mean of 10.3% annually, followed by a lower annual growth rate of 2.5% from 2012 to 2019. The overall incidence of concussion injuries increased over the study period (r = 0.314), with the incidence rate in boys being greater than that of girls from 2009 to 2013. The most common cause of concussion was player-to-ground contact for boys and player-to-ball or player-to-stick contact for girls. The mean annual concussion incidences in youth lacrosse and youth football were 443 and 355 per 100,000 participants, respectively. Conclusion: Over the study period, 16% of lacrosse injuries were diagnosed as concussions, a higher mean annual incidence per 100,000 participants than that of youth football (443 vs 355). The cause of concussion was different based on sex, with higher rates of player-to-ball or player-to-stick contact in female players versus player-to-ground contact in male players.